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2010 Community Health Needs Assessment

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

2010 Community Needs Assessment


Los Angeles Metropolitan Hospital Collaborative

Collaborative Members
California Hospital Medical Center Lynn Yonekura, M.D., Director of Community Benefits
Childrens Hospital Los Angeles Ellen Zaman, Director of Community Affairs
Good Samaritan Hospital Sammy Feuerlicht, Vice President, Strategic Planning and Development and Tom Baumann, Director, Physician
Development
Kaiser Foundation Hospital, Los Angeles Mario Ceballos, Community Benefit Manager
St. Vincent Medical Center Jan Stein, Vice President and Executive Director, St. Vincent Foundation

The Community Needs Assessment, as part of the SB697 requirements, was conducted by the Center for Nonprofit Management.

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Overview and History


Established by the Daughters of Charity of St. Vincent de Paul in 1856, St. Vincent Medical Center (SVMC) has been meeting the needs of our
community for more than a century. When the Daughters of Charity first arrived in 1856, Los Angeles was a small community with no formal
medical care. The Daughters responded to this need by opening the citys first free standing hospital in a tiny adobe house. As the communitys
health care needs grew, the Daughters adapted by opening larger facilities. Over the years, the hospital continued to grow and play an
important role in the Los Angeles health care community.
Mission
St. Vincent Medical Center subscribes to the mission of the Daughters of Charity Health System: In the spirit of our founders, St. Vincent de Paul,
St. Louise de Marillac, and St. Elizabeth Ann Seton, the Daughters of Charity Health System is committed to serving the sick and the poor. With
Jesus Christ as our model, we advance and strengthen the healing mission of the Catholic Church by providing comprehensive, excellent
healthcare that is compassionate and attentive to the whole person: body, mind and spirit. We promote healthy families, responsible
stewardship of the environment, and a just society through value based relationships and community based collaboration.
Services
Located in downtown Los Angeles, St. Vincent Medical Center is a 347 bed regional acute care, tertiary referral center hospital offering advanced
care delivered by some of the most well respected medical professionals in the world. Through combined knowledge, compassionate healing
and a commitment to our community, St. Vincent Medical Center is advancing healthcare.
St. Vincent Medical Centers specialty areas include: the Los Angeles Cancer Institute, the Los Angeles Heart Institute, the Multi Organ Transplant
Center, the Los Angeles Spine Surgery Institute, and the House Ear and Neurosurgery Center. In addition, St. Vincent Medical Center offers the
latest diagnostic and treatment technologies and a full continuum of care to benefit patients and their families. Other services provided include,
but are not limited to, the Center for Health & Healing, the Comprehensive Liver Disease Center, rehabilitation, outpatient dialysis, and
laboratory services.
Service Area
St. Vincent Medical Center is located in Service Planning Area (SPA) 4 of Metro Los Angeles. Its service area, however, extends over a larger
regional area with patients coming to SVMC from over 80 cities in Los Angeles, San Bernardino, Riverside and Orange Counties, as well as from
across the county and around the world.

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

The primary service area of SVMC includes all or portions of the SPAs, Health Districts, cities and communities, and 21 zip codes:
Service Planning Areas
SPA 4 Metro Los Angeles
SPA 6 South

Health Districts
HD 9 Central
HD 34 Hollywood/Wilshire
HD 47 Northeast
HD 69 South
HD 72 Southeast
HD 75 Southwest

Cities/Areas
Crenshaw
Echo Park
Hollywood
Northeast Los Angeles
Pico Union
South Central
West Hollywood
Westlake
Wilshire

90004
90005
90006
90007
90008
90010
90011
90016
90017

Zip Codes
90018
90019
90020
90026
90027
90028
90029
90031
90037

90044
90046
90057

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Table of Contents

I. QUANTITATIVE (Secondary Data Sources)

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A. COMMUNITY HEALTH PROFILE......

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1
2

Service Area...
Population Data..
2.1 Population count..
2.2 Age.
2.3 Citizenship
2.4 Education attainment..
2.5 Race/ethnicity...
2.6 Households..
2.7 Language spoken at home...
2.8 Marital status....
2.9 Foster care population.
2.10 Poverty rate.
2.11 Household income (median).
2.12 Class of workers by industry
2.13 Employment status, including unemployment.
2.14 Means of transportation to work.
Natality
3.1 Prenatal care..
3.2 Birth weight.
3.3 Births by Zip Code
3.4 Birth by mothers race/ethnicity and age ...............................................................
Mortality
4.1 Deaths.
4.2 Cause of death..

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

4.3

Premature death.

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B. ACCESS.. 52
1 Health Insurance..
1.1 Type and status..
1.2 Healthy Families disenrollment..
2 Regular Source of Care.
2.1 DHS use in the past year
3 Specialty Care .
3.1 Special health care needs
4 Emergency Room Use
4.1 Emergency room use for children.
5 Barriers to Access.
5.1 Difficulty in accessing care.
5.2 Could not afford to see a Medical Doctor..
5.3 Could not afford mental health care..
5.4 Could not afford dental care.
5.5 Could not afford eyeglasses..
5.6 Could not afford medication (Rx) .
5.7 Transportation barrier..
5.8 Language barrier...
6 Senior Care
7 Community Clinics
8 Disability

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C. HEALTH BEHAVIORS AND PREVENTIVE CARE. 74


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3
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Childhood Immunization..
Influenza and Pneumonia Vaccinations among Elderly Adults ...
Cholesterol Screening..
Dental Care.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

5
6

Health Literacy.
Fitness and Nutrition.
6.1 Physical activity..
6.2 Limited activity (number of days) ...
6.3 5 servings of fruits and vegetables...
6.4 Breakfasts (daily consumption) .
6.5 Fast food.

D. RISK BEHAVIORS..
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2

4
5
6

Obesity.
1.1 Overweight and obesity...
Smoking.
2.1 Established smokers...
2.2 Smoke exposure.
Alcohol use..
3.1 Binge drinking..
3.2 Chronic drinking.
Drug use.
Youth involved in Gangs..
Youth arrest/felonies..

E. CHRONIC DISEASES......
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2
3
4
5
6

Diabetes...
Asthma..
2.1 Childhood Asthma Hospitalization Rate.
Heart Disease.
Arthritis.
High blood cholesterol .......................
Hypertension/high blood pressure.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

F. CANCER..
1
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3
4

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Case of invasive cancer .


Colorectal cancer screening (blood stool tests) ..
Cervical cancer screenings (pap smear) .
Breast cancer screenings (mammogram) .

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G. HIV/AIDS......

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HIV/AIDS..
1.1 HIV/AIDS, for Adolescents..

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H. COMMUNICABLE DISEASES...

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2
3
4
5
6

I.

J.

Tuberculosis....
Hepatitis A..
Hepatitis B..
Hepatitis C...
Pertussis ..
Sexually Transmitted Infections...

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MENTAL HEALTH....

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1
2
3
4

Mental illness, patients under 20 Years.


Alcohol drug induced mental illness.
Depression..
Attention Deficit Hyperactivity Disorder (ADHD)....

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COMMUNITY AND SOCIAL ISSUES........

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3
4
5
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Domestic Violence .
Child Abuse and Neglect..
Teenage Pregnancy..
Immigration......
School dropouts...
Self reported health status..

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

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Average number of unhealthy days..


Carbon monoxide..
Parks and open space..
Particulate matters...
Housing.
11.1 Housing units.....
11.2 Occupied versus vacant units..
11.3 Renter versus owner occupied units...
11.4 Units in structure ..
11.5 Median home value.
11.6 Vehicle available..
11.7 Average length of residence.
11.8 Year housing structure was built ...
11.9 Transition services for adults with pediatric illnesses.
Safety/Crime..
Safe parks.
Gentrification, spec. Downtown L.A. ..
Homelessness, spec. new homeless..
Food Insecurity.
Economy downturn.....
Unemployment and job market..
Alcohol Distributors..
Alcohol Outlets per 1,000 People ...

II. Qualitative (Primary Data Sources)


A. COMMUNITY FOCUS GROUPS ...
B. KEY INFORMANT INTERVIEWS .....

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

List of Figures
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GSH Service Zip Codes and Population for 2009


Population by SPA, 2010
Age Distribution in SVMCs Primary Service Area, 2009
Persons Naturalized Nationally, Statewide and by Core Based Statistical Area (CBSA) of Residence, 2009
Educational Attainment in SVMCs Primary Service Area, 2009
Educational Attainment by SPA, 2010
Race/Ethnicity Percentages in SVMCs Primary Service Area, 2009
Number of Households by SPA, 2009
Number of Households in SVMCs Primary Service Area, 2009
Percentage of Language Spoken at Home in SVMCs Primary Service Area, 2009
Percentage of Individuals Married, Never Married, Divorced or Widowed in SVMCs Primary Service Area, 2009
Foster Care Population* in SVMCs Primary Service Area, 2008
Child Abuse Allegation Referrals in SVMCs Primary Service Area by Zip Code, 2008
DCFS Removals in SVMCs Primary Service Area by Zip Code, 2008
Percentage of Families Living Below Federal Poverty Level in SVMCs Primary Service Area, 2010
Percentage of Families Living At or Above the Federal Poverty Level in SVMCs Primary Service Area, 2010
Families Living Below or At/Above Poverty by SPA, 2010
Median Household Income in SVMCs Primary Service Area, 2009
Percentage Employment Status in SVMCs Primary Service Area, 2009
Percentage Employment Status by SPA, 2010
Percentage of Live Births in Los Angeles County Service Planning Areas that are Very Low or Moderately Low Birth Weight, 2007
Percentage of Live Births that are Very Low and Moderately Low Birth Weight in each Racial/Ethnic Group, LA County, 2007 2008
Number of Births in SVMCs Primary Service Area, 2008
Percentage of Births by Mothers Race/Ethnicity in SVMCs Primary Service Area, 2008
Births by Mothers Race/Ethnicity by SPA, 2008

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

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Birth by Mothers Age in SVMCs Primary Service Area, 2008


Birth by Mothers Age in SVMCs Primary Service Area, 2008
Number of Deaths in SVMCs Primary Service Area, 2008
Total Number of Deaths by SPA, 2008
Deaths by Age Group in SVMCs Primary Service Area, 2008
Cause of Death in SVMCs Primary Service Area, 2008
Ranking of Premature Death by SPA, 2007
Percentage of Population Ages 0 64 without Health Insurance Coverage in SVMCs Primary Service Area, 2005
Percentage of Adults (18+ years) Reported Having a Regular Source of Health Care by SPA, 2007
Percentage of Adults (18+ years) Reported Receiving Medical Services from LA County Health Department Facilities in the Past Year by
SPA, 2005
Twelve Program Indicators to Measure, Monitor and Report
Percentage of Children Enrolled in Special Education, 2008
Percentage of Hospital Diversion to 911 Traffic Due to Emergency Department Saturation in SVMCs Primary Service Area, 2010
Percentage of Hospital Diversion to 911 Traffic Due to Emergency Department Saturation by SPA, 2010
Los Angeles County EMS Agency Pediatric Trauma Hospital Volume, 2006
Los Angeles County EMS Agency Pediatric Trauma Hospital Volume, 2006
Percentage of Adults (18+ years) Who Reported That Obtaining Medical Care When Needed Is Somewhat or Very Difficult by SPA,
2007
Percentage of Adults (18+ years) Unable to See a Doctor in the Past Year Because They Could Not Afford It by SPA, 2007
Percentage of Adults (18+ years) Unable to Receive Mental Health Care or Counseling in the Past Year Because They Could Not Afford
It by SPA, 2007
Percentage of Adults (18+ years) Unable to Obtain Dental Care in the Past Year Because They Could Not Afford it by SPA, 2007
Percentage of Adults (18+ years) Unable to Obtain Eyeglasses in the Past Year Because They Could Not Afford It by SPA, 2005
Percentage of Adults (18+ years) Who Did Not Get Prescription Medication in the Past Year Because They Could Not Afford It by SPA,
2007
Percentage of Adults (18+ years) Who Reported Transportation Problems Kept Them from Obtaining Medical Care in the Past Year by
SPA, 2007

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

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Percentage of Adults (18+ years) Who Completed the Survey Interview in a Non English Language in the Past Year and Who Also
Reported Difficulty Talking to a Doctor or Health Care Professional Because of a Language Barrier by SPA, 2007
California Population Age 60+ Growth Trends (in Millions), 2007
Primary Care Clinic Demographic & Utilization Information, Los Angeles County, 2007
Primary Care Clinic Selected Procedural Information, Los Angeles County , 2007
LA County DHS and PPP Program Providers Primary Care Clinic Selected Procedural Information by SPA, 2007
Disability Percentage Prevalence by State, 2008
Estimated Vaccination Coverage for Vaccination Series (modified)* and Selected Individual Vaccines Among Children aged 19 35
Months by State and Local Area National Immunization Survey, United States, 2009
Percentage of Adults (65+ years) Reported Receiving a Flu Shot in the Past 12 Months by SPA, 2007
Percentage of Adults (65+ years old) Reported Ever Having a Pneumonia Vaccination by SPA, 2007
Percentage of Adults (18+ years) Diagnosed with High Blood Cholesterol by SPA, 2007
Prevalence of Physical Activity for Adults (18+ years) by SPA, 2007
Average Days in the Past 30 Days of Limited Activity Due to Poor Physical and/or Mental Health for Adults (18+ years) by SPA, 2007
Percentage of Those Consuming 5 Fruits and Vegetables Per Day (Population 5 and Over) in SVMCs Primary Service Area, 2005
Percentage of Adults (18+ years) Reported Having Eaten 5 or More Servings of Fruits/Vegetables in the Past Day by SPA, 2007
Percentage of Parents of Children (2 17 Years Old) Who Reported Their Child Ate Breakfast Daily in a Typical Week by SPA, 2007
Percentage of Children (2 17 Years Old) Who Ate Fast Food Yesterday by SPA, 2005
Percentage of Overweight and Obese (12+ years) by SPA, 2007
Overweight and Obese (12+ years) in SVMCs Primary Service Area, 2005
Percentage of Adults (18+ years old) who Smoke Cigarettes by SPA, 2005
Percentage of Adults (18+ years) Who Are Current, Non Regular, Former and Non Smokers by SPA, 2007
Percentage of Parents of Children (0 17 Years) Who Reported Their Child Exposed to Tobacco Smoke in the Home by SPA, 2005
Percentage of Adults (18+ years) Who Reported Drinking Alcohol in the Past Month by SPA, 2007
Percentage of Adults (18+ years) Who Reported Binge Drinking* in the Past Month by SPA, 2007
Percentage of Adults (18+ years) Who Reported Chronic/Heavy Drinking* in the Past Month by SPA, 2007
Percentage of Adults (18+ years) Who Reported Receiving Treatment (in the past 5 years) for Substance Abuse or Addiction by SPA,
2007

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

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Reports of Gang Membership by California County, 2006 2008


Juvenile Felony Arrest Rate by California County, 2008
Comparison of Prevalence of Diabetes among Adults Age 45 and Over By SPA, 2007
Percentage Diagnosed with Diabetes*(Adults Age 45 and Over) in SVMCs Primary Service Area, 2005
Percentage of Individuals Diagnosed with Asthma by SPA, 2007
Percentage of Individuals (All Ages) with Asthma in SVMCs primary service area, 2005
Percentage of Parents of Children (0 17 Years) Who Reported Their Child Ever Diagnosed with Asthma and Currently Still Have Asthma
or Had an Asthma Attack in the past 12 months by SPA, 2007
Childhood Asthma Hospitalization Rate Per 1,000,000 People Under 20 in SVMCs Primary Service Area, 2007
Percentage of Adults (18+ years) Diagnosed with Heart Disease by SPA, 2007
Percentage of Adults (18+ years old) Diagnosed with Arthritis by SPA, 2005
Percentage of Adults (18+ years) Diagnosed with High Blood Cholesterol by SPA, 2007
Percentage of Adults (18+ years) Diagnosed with Hypertension by SPA, 2007
Percentage of Adults (50+ years) Reported Having a Blood Stool Test Within the Past Two years by SPA, 2007
Percentage of Adult Women (18+ years) Reported Having a Pap Smear (within the past 3 years for 2007, 2005 & 2002 03; within past 2
years for 1999 00) by SPA, 1007
Percentage of Women (40+ years) Reported Having a Mammogram in the Past Two Years by SPA, 2007
Percentage of Women (50+ years) Reported Having a Mammogram in the Past Two Years by SPA, 2007
Cases of AIDS by Year of Diagnosis and Deaths among AIDS Cases, Los Angeles County, 2009
Annual Cases of AIDS by SPA, 2009
Number of persons living with AIDS in SVMCs Primary Service Area by Gender and Ethnicity by SPA, 2009
Number of Deaths Among AIDS cases by SPA, 2007
TB Cases and Rates (Cases per 100,000 population) for Los Angeles County, 2007
TB Cases and Rates (Cases per 100,000 population) by Gender, Ethnicity and Age for Los Angeles County, 2007
Reported Hepatitis A, Acute Cases and Rates per 100,000 by SPA, 2008
Reported Hepatitis B, Acute Cases and Rates per 100,000 by SPA, 2008
Reported Hepatitis C, Acute Cases and Rates per 100,000 by SPA, 2008
Pertussis Rate per 100,000 Population of Reported Cases*, by Race/Ethnicity and Age California, January 1 June 30, 2010

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

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Percentage of Children (3 17 years) Unable to Afford Mental Health Care or Counseling in the Past Year by SPA, 2007
Number of Alcohol and Drug Related Mental Illness Cases in SVMCs Primary Service Area, 2007
Percentage of Adult (18+ years) Diagnosed with Depression in SVMCs Primary Service Area, 2007
Percentage of Adults (18+ years) Diagnosed with Depression by SPA, 2007
Percentage of Children (3 17 Years) Diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) by SPA, 2007
Domestic Violence Death Due to Homicide Among Females (ages 10 44 years), 2006
Domestic Violence Hospitalizations Due to Violent Injuries Among Females (ages 13 and over), 2006
Domestic Violence Adult Arrests for Spousal Abuse, 2006
Domestic Violence Related Calls for Assistance in the Adult Population (age 18 and over), 2006
Domestic Violence Related Calls for Assistance Involving Weapons, 2006
Substantial Maltreatment Reports for Children Less Than One Year, Rate per 1,000 children, 2008
Foreign Born Population in Los Angeles County 2008 estimates
Foreign born population by Age Group in Los Angeles County, 2006 2008
High School Dropout Rates by California County, 2008
Percentage of Adults (18+ years old) who Reported Fair/Poor Health Status by SPA, 2007
Average Number of Unhealthy Days (Mental and/or Physical) in the Past 30 days for Adults (18+ years) by SPA, 2007
Protected Areas per 1,000 People (Acre) in SVMCs Primary Service Area, 2009
Number of Households by SPA, 2009
Number of Households by SVMCs Primary Service Area, 2009
Occupied and Vacant Units in SVMCs primary service, 2010
Owner occupied vs. Renter occupied Housing Units in SVMCs Primary Service Area, 2010
Owner vs. Renter Occupied Housing Units by SPA, 2010
Units in Structure in SVMCs Primary Service Area, 2010
Units in Structure by SPA, 2010
Owner occupied Median Home Values in SVMCs Primary Service Area, 2010
Number of Passenger Cars, Vans, and Pickup/Panel Trucks Kept at Home and Available for Transportation
Homicides by Firearm in SVMCs Primary Service Area, 2006

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

127. Percentage of Children (1 17 Years Old) whose Parents Reported Easy Access to a Park, Playground or Other Safe Place for Recreation
by SPA, 2007
128. Downtown Los Angeles Residential Race/Ethnicity, 2006 & 2008
129. Los Angeles Continuum of Care by Sheltered and Unsheltered Persons by SPA, 2009
130. Los Angeles Continuum of Care by Gender and Ethnicity, 2009
131. Trends in Food Insecurity among Households by SPA, 2007
132. Percentage of Adults Diagnosed with diabetes or borderline/pre diabetes by SPA, 2009
133. Number of Alcohol Distributors in SVMCs primary service area, 2009
134. Number of Alcohol Distributors in SVMCs Primary Service Area, 2009
135. Percentage of Adults who Reported Binge Drinking* in the Past Year, 2009
136. Number of Alcohol Outlets per 1,000 in SVMCs Primary Service Area, 2009
137. Focus group characteristics, 2010
138. Health issues/trends identified by focus group participants
139. Health services that are lacking identified by focus groups
140. Barriers to health care identified by focus groups
141. How to address barriers identified, from two focus groups
142. Healthy behaviors hardest to promote
143. What preventative health care means to focus group participants
144. Where do people go for information on health services
145. Role hospitals could play
146. Non health community issues identified in focus groups
147. Health related issues identified by key informants
148. Health needs identified by key informants
149. Barriers to health care services identified by key informants

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Appendices
Appendix
1. Sources
2. Percent of Adults (18+ years old) Reported Having a Regular Source of Health Care by Health District, 2007
3. Percent of Adults (18+ years old) Reported Received Medical Services from LA County Health Department Facilities in the Past Year by
Health District, 2005
4. Percent of Children (0 17 years old) who Meet Criteria for Having Special Health Care Needs (SHCNs)11 by Health District, 2005
5. Percent of Adults (18+ years old) Who Reported That Obtaining Medical Care When Needed Is Somewhat or Very Difficult by Health
District, 2007
6. Percent of Adults (18+ years old) Unable to See a Doctor for a Health Problem When Needed in the past year Because They Could Not
Afford It by Health District, 2007
7. Percent of Adults (18+ years old) Unable to Receive Mental Health Care or Counseling When Needed in the Past Year Because Could Not
Afford It by Health District, 2007
8. Percent of Adults (18+ years old) Unable to Obtain Dental Care (Including Check Ups) in the Past Year Because They Could Not Afford it
by Health District, 2007
9. Percent of Adults (18+ years old) Unable to Obtain Eyeglasses When Needed in the Past Year Because They Could Not Afford It by Health
District, 2005
10. Percent of Adults (18+ years old) Who Reported Did Not Get Prescription Medication When Needed in the Past Year Because Could Not
Afford It by Health District, 2007
11. Percent of Adults (18+ years old) Unable to Obtain Dental Care (Including Check Ups) in the Past Year Because They Could Not Afford it
by Health District, 2007
12. Percent of Adults (18+ years old) Reported Transportation Problems Kept Them from Obtaining Needed Medical Care in the Past Year by
Health District, 2007
13. Percent of Adults (18+ years old) who Completed the Survey Interview in a Non English Language in the Past Year and who also Reported
Difficulty Talking to a Doctor or Health Care Professional Because of a Language Barrier by Health District, 2007
14. Percent of Adults (65+ years old) who Reported Receiving a Flu Shot in the Past 12 Months by Health District, 2007

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

15. Percent of Adults (65+ years old) Reported Ever Having a Pneumonia Vaccination by Health District, 2007
16. Percent of Adults (18+ years old) Diagnosed with High Blood Cholesterol by Health District, 2007
17. Prevalence of Physical Activity for Adults (18+ years old) by Health District, 2007
18. Average Days in the past 30 days of Limited Activity Due to Poor Physical and/or Mental Health for Adults (18+ years old) by Health
District, 2007
19. Percent of Parents of Children (2 17 Years Old) who Reported Their Child Ate Breakfast Daily in a Typical Week by Health District, 2007
20. Percent of Children (2 17 Years Old) Who Ate Fast Food Yesterday by Health District, 2005
21. Percent of Adults (18+ years old) who Smoke Cigarettes by Health District, 2005
22. Percent of Adults (18+ years old) Reported Established Cigarette Smoker (Smoked at Least 100 Cigarettes and Currently Smokes) by
Health District, 2007
23. Percent of Parents of Children (0 17 Years Old) Who Reported Their Child Exposed to Tobacco Smoke in the Home by Health District,
2005
24. Percent of Adults (18+ years old) who Reported Drinking Alcohol in the Past Month by Health District, 2007
25. Percent of Adults (18+ years old) who Reported Binge Drinking3,3a in the Past Month by Health District, 2005
26. Percent of Adults (18+ years old) who Reported Chronic Drinking3 in the Past Month by Health District, 2005
27. Percent of Adults (18+ years old) Diagnosed with Heart Disease by Health District, 2007
28. Percent of Adults (18+ years old) Diagnosed with Arthritis by Health District, 2005
29. Percent of Adults (18+ years old) Diagnosed with Hypertension by Health District, 2007
30. Percent of Adults (18+ years old) Diagnosed with High Blood Cholesterol by Health District, 2007
31. . Percent of Adults (50+ years old) Reported Having a Blood Stool Test within the past 2 years by Health District, 2005
32. Percent of Adult Women (18+ years old) Reported Having a Pap Smear by Health District, 2007
33. Percent of Women (40+ years old) Reported Having a Mammogram in the Past 2 Years by Health District, 2007
34. Percent of Women (50+ years old) Reported Having a Mammogram in the Past 2 Years by Health District, 2007
35. TB Cases by Health District, 2007
36. Trend of Chlamydia, Gonorrhea, Syphilis Reported for Los Angeles County Residents, 2004 2008

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

37. Reported Chlamydia Cases and Rates per 100,000 Population by Service Planning Area (SPA)1 and Health District (HD), Los Angeles
County, 2004 2008
38. Reported Gonorrhea Cases and Rates per 100,000 Population by Service Planning Area (SPA)1 and Health District (HD), Los Angeles
County, 2004 2008
39. Reported Primary and Secondary Syphilis Cases and Rates per 100,000 Population by Service Planning Area (SPA)1 and Health District
(HD), Los Angeles County, 2004 2008
40. Percent of Children (3 17 years old) whose Parents Reported They Were Unable to Afford Mental Health Care or Counseling for Their
Child in the Past Year by Health District, 2007
41. Percent of Adults (18+ years old) Diagnosed with Depression by Health District, 2007
42. Percent of Adults (18+ years old) who Reported Fair/Poor Health Status by Health District, 2007
43. Average Number of Unhealthy Days9 (Mental and/or Physical) in the past 30 days for Adults (18+ years old) by Health District, 2007
44. 2009 to 2010 Median Home Values by Metro Collaborative Cities by Health District, 2010
45. Percent of Children (1 17 Years Old) whose Parents Reported Easy Access to a Park, Playground or Other Safe Place for their Child to Play
by Health District, 2007

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Background and Purpose


In 1994, the California State Legislature enacted Senate Bill 697 (SB 697) requiring non profit hospitals to conduct a needs assessment every
three years. Based on the needs and priorities identified in the tri annual assessment, the hospital will develop a community benefit plan. The
plan will include proposed activities designed around disease prevention efforts and improvement of health status. A needs assessment has
been conducted every three years since 1995 that includes most of the current Los Angeles Metropolitan Hospital Collaborative members.
In order to complete the 2007 Community Needs Assessment, five hospitals pooled resources to collect information about the health and well
being of residents in their service community. This group, called the Los Angeles Metropolitan Hospital Collaborative is described below.

Metro Collaborative Members


California Hospital Medical Center
California Hospital Medical Center (CHMC) has been a proud community member for more than a century. Founded in 1887 by three
physicians, CHMC has one of the largest groups of community health educators Promotoras in existence. CHMC is a non profit, acute care
hospital with 313 private beds and sustains its community by raising funds for program enhancement and services that benefit both the
Downtown and the Central City areas.
Childrens Hospital Los Angeles
Established in 1901, Childrens Hospital provides health care to seriously ill and injured children and adolescents in Los Angeles County and is a
major referral center for specialized care. It is a local, regional, and national resource for pediatric clinical care, teaching and research.
Good Samaritan Hospital
Good Samaritan Hospital (GSH) is both a community hospital and a regional tertiary medical center with a tradition for caring since it opened
in 1885. The hospital represents Los Angeles' multicultural community and has an international reputation as a world class medical center.
Collectively, medical staff and employees speak almost 60 languages/dialects and offer outstanding diagnostic, surgical and therapeutic care in
a state of the art setting. Annually, the hospital admits approximately 17,000 patients and provides more than 90,000 outpatient visits.
Kaiser Foundation Hospital Los Angeles
Kaiser Foundation Hospital Los Angeles (KFH LA) is a 507 licensed bed acute care hospital offering both primary and tertiary care services. It is
situated on approximately 17.9 acres in the East Hollywood/Los Feliz area. It is the tertiary care center for Kaiser Permanente members
throughout Southern California, with outstanding programs in cardiac surgery, radiation oncology, spine surgery, and epileptic surgery. In
addition, the medical center is home to The Center for Medical Education, which includes an extensive graduate medical education program
with 165 interns, residents, and fellows in 18 different specialties and subspecialties. The medical center has a staff of more than 4,500
employees and physicians, and outlying facilities in East Los Angeles, Glendale, Pasadena, and a mental health center in Chinatown.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

St. Vincent Medical Center


Los Angeles first hospital, St. Vincent Medical Center, was founded by the Daughters of Charity of St. Vincent de Paul in 1856. Since that time,
the hospital has grown into a 347 bed regional acute care, tertiary referral center, specializing in heart care, cancer care, spine care, multi organ
transplantation, and the treatment of ear and hearing disorders. Committed to serving its community, St. Vincent Medical Center provides
comprehensive, excellent healthcare that is compassionate and attentive to the whole person body, mind and spirit.

Planning the Community Needs Assessment


The first step in the project design was to work with the Los Angeles Metro Collaborative to review the previous needs assessment and the
community benefit plans from 2004 and 2007, in order to refine the focus areas and identify additional data sources to update local
demographic and descriptive data for communities served by each member hospital. From this review, recommendations were put forth to the
Collaborative, who were asked to assist in setting priorities of the needs assessment as well as to determine the preferred format for the final
report.
The Center for Nonprofit Management (CNM) in collaboration with Special Service for Groups (SSG) created a variety of data collection
instruments, including standardized interview protocols, survey forms, document analysis tools and focus group protocols used in needs
assessments in general and specifically for the 2004 and 2007 needs assessment for the hospital collaborative. These instruments provided
useful templates for this needs assessment and were refined to ensure all instruments were clear and could be used effectively, a primary
consideration of the collaborative.

Organization of Report
This report summarizes key quantitative and qualitative findings for the Los Angeles Metro Collaborative. Specific demographic community
profiles are summarized for SVMC. Overall, findings are organized in narrative and graphic formats by Service Planning Area (SPA), and/or zip
codes. Findings are organized by the following major content areas:
Community Health Profile
Health Access
Health Behaviors and Preventative Care
Risk Behaviors
Chronic Diseases
Cancer

HIV/AIDS
Communicable Diseases
Mental Health
Community and Social Issues

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Methods
As in the assessments conducted for the hospital collaborative in 2004 and in 2007, CNMs approach was to emphasize the central importance of
input from knowledgeable, involved community stakeholders. These key informants are a preferred alternative to a community survey, since
a scientific (probability) sample community survey of sufficient size and response rate would not be feasible, affordable, or as effective.
Community leaders who could represent community interests more efficiently and accurately than a community survey were identified by the
hospitals. Leaders and managers from participating hospitals and community based agencies participated by sharing their perceptions about
the landscape of health care needs and barriers in their communities. Other community members and service recipients chosen by community
based agencies provided a broader and more precise perspective about health care services, gaps in services, and suggestions about how to fill
them. Key informants added important knowledge and experience for their target areas. Their input made it possible to conduct an informative
needs assessment with direct implications for policies and resource allocation to meet the individual member hospitals specific priorities.
In addition, the team complemented this qualitative approach with the compilation and analysis of secondary data. Because Census 2010 data
was not available, 2009 Claritas/Nielsen projection data were used for general demographics and were compiled by Service Planning Areas
(SPAs), and zip codes when available. Existing data was also utilized from the Los Angeles County Department of Health Services for
health/community need indicators, capacity needs or barriers, and benchmarking standards. Most of the quantitative data for the 2010 needs
assessment was culled from the latest Los Angeles County Health Survey and are available by SPAs and HDs. Because the Health Survey has
been implemented regularly, we were also able to detect trends in the various geographies going back as far as 1997 for most indicators.
Additional data sources were mined as part of the literature review process during the early phase of the needs assessment

Document Reviews
Existing data and data sources were reviewed with the hospital collaborative to identify which data variables would be most helpful in setting
priorities for each individual member hospital. Additionally, staff reviewed administrative data.

Primary Data Collection


The Project Team conducted interviews, focus groups and collected existing secondary data. Candidates for focus groups and interviews were
selected with the assistance of hospital collaborators and other recommendations from key informants during the data collection process.
Project staff strictly adhered to standard ethical guidelines for research and maintained the confidentiality required to ensure the protection of
participants and security of all data collected under this project. Data collection activities were conducted in English and Spanish to ensure
community representatives in fact reflect the residents in these target areas.
Focus groups Topics in the focus group included major areas from previous needs assessments and other issues anticipated to be important in
health care. Areas covered were: health care utilization, preventive and primary care, health insurance, access and barriers to care, emergency
room use, chronic disease management and community issues. Groups that hospitals commonly identified as important stakeholders in the

21

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

needs assessment were prioritized. These groups included residents from major ethnic groups, geographic areas and service providers in the
Collaboratives primary service areas. Residents from ethnic communities were African American and Latino, representing areas of downtown
Los Angeles, East Los Angeles and other metro areas. Translation was provided in the Latino focus groups. Seniors, community health
promoters and service providers were gathered separately. Ten focus groups were conducted to cover the number of communities served by
the hospital collaborative. A majority of these focus groups were done with community residents identified by community agencies involved in
previous needs assessments and by the collaborative. Two focus groups included representatives of community agencies and service providers
who interacted with residents on issues related to health care.
Interviews Thirty interviews were conducted to gather information about the needs and challenges faced by the community in accessing and
utilizing health care services. Thirty key informant interviews were conducted to ensure reliable and representative information. Key
informants included staff at collaborative hospitals and health care service organizations in the primary service areas. Interviews were
conducted over the phone or in person and lasted approximately 45 minutes.

Secondary Data Collection


To the extent necessary, secondary or existing datasets were accessed to update the previous needs assessment. Data sources for this purpose
include reports from the Los Angeles County Department of Health Services, including the Los Angeles Health Survey, Key Indicators of Health
and Recent Health Trends in Los Angeles, and additional data on live births and deaths. Additionally, the Project Team utilized 2009 projection
data, instead of relying on outdated 2000 Census data (the 2010 Census data would not be available until after this project is completed, and
American Community Survey data are not available in the lowest geography, such as zip codes or census tracts, desired by the hospital
collaborative).
In addition, information from online sources such as Healthy City, United Way, as well as foundations conducting health research related to the
needs and resources available in Los Angeles, was incorporated as appropriate. Data serving as social indicators was assembled from a number
of data bases and included socioeconomic information, statistics on crime, violence and on quality of housing. The pertinent research literature
was searched to verify or complement the most up to date information on local demographic and health statistics. Secondary data and
reference materials were retrieved from web based sources and electronic files in addition to paper documents gathered through literature
searches and from recommendations made by key informants.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

I. Quantitative
A.

COMMUNITY HEALTH PROFILE

1. Service Area
St. Vincent Medical Center (SVMC) provides health services to individuals residing in twenty one zip codes within two of the eight Service
Planning Areas (SPAs) throughout Los Angeles County. Please note that from this point on St. Vincent Medical Center will be referred to as
SVMC.

2. Population Data
2.1 Population Count
In 2009, the U.S. Census Bureau reported an estimated total Los Angeles County population of 9,848,011 residents (U.S. Census, 2010). Of the
total County population, about 11.3% (or 1,114,255 individuals) resided within the SVMCs (Nielsen Claritas, Inc., 2010). The highest populated
zip code within SVMC is 90011 at 108,722 residents, followed by zip code 90044 with 92,871 residents (Nielsen Claritas, Inc.). In contrast, the
least geographically populated zip codes serviced are zip codes 90010, with 2,215, and 90017 with 27,700 residents (Nielsen Claritas, Inc.).
Figure 1. SVMC Service Zip Codes and Population for 2009
Zip Code
Population

90004
70,525

90005
46,215

90006
67,475

90007
46,513

90008
31,499

90010
2,215

90011
108,722

90016
49,427

90017
27,700

90018
50,504

Zip Code
Population

90020
47,190

90026
74,633

90027
51,079

90028
31,576

90029
44,380

90031
40,555

90037
60,210

90044
92,871

90046
51,428

90057
49,960

90019
70,215

Total Population Count


Los Angeles County Population

Population Count
571,010
Population Count
543,882
1,114,892
10,022,189

Source: HealtyCity.org (Nielsen Claritas, Inc), 2010

By SPA, the largest populated area is San Fernando, followed by San Gabriel, and the South Bay. The least populated SPA is West. Population
statistics and proportions for each SPA are detailed in Figure 2 below.

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7 Community Health Needs Assessmen
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Figure 2. Po
opulation by SPA
A, 2010
Number of
Householdss
9,848,011

Percenttage of Los
Angele
es County
10
00%

S
Service
Planning Area
A
S Fernando (2)
San

2,106,690

21
1.4%

S Gabriel (3)
San

1,836,622

18
8.6%

Metro (4)

1,207,063

2.3%
12

West (5)
W

654,766

6.6%

SSouth (6)

971,522

9.9%

East (7)

1,322,122

3.4%
13

SSouth Bay (8)

1,515,367

15
5.4%

Los Angeles Countty

Sources: HealtyCity.orgg (Nielsen Claritas, Inc), 2010


U.S. Census, 20
010

2.2 Age
Children and youth (ages 0 17) accounted for moree than one quarter (26.5%) of thee population in SV
VMCs primary seervice area, includ
ding almost
8% who were und
der the age of 5. Less than 1 in 10
0 people in this population were age 65 and abovee. Please see Figu
ure 3 for more daata.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 3. Age Distribution in SVMCs Primary Service Area, 2009


20%
16.0%

16.2%

15%
10%
5%

7.8% 7.2% 7.3%


4.2% 4.6%

6.1%

7.0%

5.9%

4.9%

4.7%
3.6%

2.9%

1.3%

0%

Source: Nielsen Claritas, Inc., 2009

It should be noted that in 2030, when all of the baby boomers reach 65 and older, they will make up nearly one in five U.S. residents. Sixty five
and older populations are expected to double in size by year 2050 to 88.5 million from 38.7 million in 2008. Eighty five and older populations are
expected to more than triple, from 5.4 million to 19 million between 2008 and 2050.
Few focus group and interview participants discussed the increasing proportion of the aging population, as the baby boomer generation gets
older and advocated expansion of services for this population.
2.3 Citizenship
The United States is projected to be more racially diverse and much older by the midcentury mark. The U.S. Census Bureau projections report
that immigrants arriving to the county after 1990, including their children, are expected to make up two thirds of the population growth in the
U.S. between 2000 and 2050, when the total population will increase from 281 million to 404 million. Estimates indicate that these immigrants
and their children will comprise more than one out of every four American residents in the year 2050.
The Census 2008 National Population Projections highlights that minorities will become the majority in 2042 and by the year 2023 minorities will
comprise more than half of all children.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

According to the 2009 American Community Survey, of the estimated 307,006,556 people living in United States, 86.1% of the population were
U.S. citizens born in the United States, 5.5% were U.S. citizens by naturalization and 7.1% were not a U.S. citizen. In California 28.4% are
naturalized citizens. However, nearly half (47.4%) of Californias naturalized citizens are from Los Angeles, Long Beach and Santa Ana1.
Throughout the years, that rate has remained steady.
Figure 4. Persons Naturalized Nationally, Statewide and by Core Based Statistical Area (CBSA) of Residence, 2009
Percentage of the U.S.

LA, Long Beach, Santa Ana

34.1%

169,126

Percentage of
California
56.0%

202,668

33.4%

96,852

47.8%

572,646

149,213

26.1%

69,495

46.6%

2003

462,435

135,599

29.3%

62,556

46.1%

2004

537,151

145,593

27.1%

66,733

45.8%

2005

537,151

170,489

31.7%

78,182

45.9%

2006

702,589

152,836

21.8%

65,811

43.1%

2007

660,477

181,684

27.5%

78,454

43.2%

2008

1,046,539

297,909

28.5%

138,618

46.5%

2009

743,715

179,754

24.2%

84,061

46.8%

6,754,988

1,917,652

28.4%

909,888

47.4%

Year

United States

2000

886,026

California
301,907

2001

606,259

2002

Total

Source: Department of Homeland Security, Office of Immigration Statistics, Yearbook of Immigration Statistics 2009

2.4 Education Attainment


In the SVMC primary service area, 41.7% of the population had less than a high school education, compared to 31.0% of the overall population in
Los Angeles County. All but four of 21 zip codes (90008, 90010, 90027, and 90028) had higher rates than Los Angeles County overall of
individuals with less than a high school education and 90011 had the highest rate (73.9%) of individuals with less than a high school diploma. A
smaller percentage of residents in this primary service area had either a high school diploma (17.6%) Bachelors or higher (21.7%) compared to
the overall Los Angeles County rates (18.9% and 24.1%, respectively).

Department of Homeland Security, Office of Immigration Statistics, Yearbook of Immigration Statistics 2009

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 5. Educational Attainment in SVMCs Primary Service Area, 2009


Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Service Area
Los Angeles
County

Less Than HS
Diploma
N
%
19141
41.7%
13866
46.1%
24856
61.2%
12367
54.9%
4134
19.8%
340
21.3%
41559
73.9%
11851
38.9%
11766
73.0%
14016
45.6%
16865
36.3%
8749
27.2%
21626
44.6%
9022
22.9%
6978
30.0%
13609
47.3%
15461
64.3%
20644
62.8%
27598
54.7%
17575
56.7%
312023
47.9%
19141
41.7%

HS or equivalent
N
%
8093
17.6%
5202
17.3%
6907
17.0%
2952
13.1%
4032
19.3%
297
18.6%
7452
13.3%
6539
21.4%
2208
13.7%
5979
19.5%
8111
17.5%
6890
21.4%
7855
16.2%
6998
17.8%
4216
18.1%
5606
19.5%
3586
14.9%
5647
17.2%
10691
21.2%
5078
16.4%
114339
17.5%
8093
17.6%

Bachelors degree
or higher
N
%
9977
21.7%
5927
19.7%
3645
9.0%
3843
17.0%
5188
24.8%
548
34.3%
1532
2.7%
3744
12.3%
744
4.6%
3179
10.3%
9675
20.8%
9347
29.1%
9987
20.6%
13856
35.2%
6171
26.6%
4201
14.6%
1697
7.1%
1357
4.1%
2400
4.8%
3947
12.7%
100965
15.5%
9977
21.7%

1979475

1205647

1535654

31.0%

18.9%

24.1%

Source: Nielsen Claritas, Inc., 2009


Note: Bolded numbers indicate zip codes with higher percentage than Los Angeles County overall of individuals with less than a high school diploma.

SPA data reveal that a majority of SPAs had a higher rate of educational attainment than Los Angeles County. In SVMCs primary service areas
the majority has less than a high school level of educational attainment (32.6% in SPA 4 and 45.5% in SPA 6).

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Fiigure 6. Educatio
onal Attainment by SPA, 2010
Less than High School

High Schoo
ol or Equivalent

Some College/A
Associates Degree Bachelors Degre
ee or Higher

1,606,15

25.0%

1,383,744

21.5%

1,648,738

25.7%

1,789,061

27.8%

SSan Fernando (2)

274,66
61

19.8%

287,897

20.8%

378,545

27.3%

445,642

32.1%

SSan Gabriel (3)

261,98
83

22.2%

254,576

21.6%

313,935

26.6%

349,508

29.6%

Metro (4)
M

264,85
51

32.6%

158,027

19.4%

166,289

20.4%

223,991

27.5%

West (5)
W

36,26
61

7.5%

62,095

12.8%

113,331

23.3%

274,932

56.5%

SSouth (6)

244,77
76

45.5%

125,261

23.3%

115,330

21.4%

52,526

9.8%

EEast (7)

266,96
66

33.6%

206,861

26.1%

195,606

24.6%

124,169

15.6%

SSouth Bay (8)

207,51
15

21.5%

212,544

22.1%

269,168

27.9%

274,445

28.5%

LLos Angeles Countyy


SService Planning Area
A

Source: Nielsen Claritas, 2010

2.5 Race/Ethnicity
In the SVMC prim
mary service areaa, the majority off the population were Hispanic/Laatino (58.7%) followed by African
n American or Blaack (13.9%),
and then White (13.2%). In Los Angeles County, the Hispanic/Latino subgroup also
o made up the majority of the po
opulation (48.1%)). However,
the second largesst subset of the population in Los Angeles County in 2009 was Whitte (27.4%), follow
wed by the Asian subgroup (12.8%
%).
Figure 7. Race/EEthnicity Percenttages in SVMCs Primary Service Area, 2009
Race/Ethniccity
White
Black or African Am
merican
American Indian an
nd Alaskan Native
Asian
Native Hawaiian an
nd Pacific Islander
Some Other Race
Two or More Racess
Hispanic/Latino
Total

SVMC
C
147,150 (13
3.2%)
155,101 (13
3.9%)
2,326 (0.2
2%)
129,362 (11
1.6%)
701 (0.1%)
2,375 (0.2
2%)
22,953 (2..1%)
653,927 (5
58.7)
1,114,255 (100.0%)

Lo
os Angeles County
2,750,423 (27.4%)
857,211 (8.6%)
22,890 (0.2%)
1,286,101 (12.8%)
22,420 (0.2%)
19,610 (0.2%)
245,452 (2.5%)
4,818,082 (48.1%)
10
0,022,189 (100.0%))

Source: Nielsen Claritass, Inc., 2009

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2.6 Households
Of the 13 million households in th
he state (12,652,2
259) of Californiaa, one in four hou
useholds was locaated in Los Angelles County (3,234
4,680).2 The
distribution of th
he number of households across SPAs show thaat the San Fernaando (SPA 2) area ranks highestt with the most number of
households at 21
1.7%, followed byy San Gabriel (SP
PA 3) at 17.4% an
nd South Bay (SPA 8) at 15.9%. SPA 4, one of SVM
MCS service plan
nning areas,
also made up a laarge percentage (13.6%, 438,522) of households. Together, SPAs 4 and 6 representt 694,963 househ
holds or 21.5% of Los Angeles
County.
mber of Households by SPA, 2009
Figure 8. Num
Number off
Householdss
3,234,680

Percenttage of Los
Angele
es County
100%

S
Service
Planning Area
A
S Fernando (2)
San

702,175

21
1.7%

S Gabriel (3)
San

563,935

17
7.4%

M
Metro
(4)

438,522

13
3.6%

West (5)
W

296,203

9.2%

SSouth (6)

LLos Angeles Countty

256,441

7.9%

East (7)

360,211

1.1%
11

SSouth Bay (8)

515,512

15
5.9%

3,132,999

96
6.9%

C
Cumulative

Source: HealtyCity.org (Nielsen Claritas, Inc), 2009. Data is approximaated.

The most populous zip codes with


hin SVMCs primary service area were 90046 (29,33
38), 90044 (25,58
89), and 90026 (2
25,034).

HealthyCity.org, 200
09

29

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 9. Number of Households in SVMCs Primary Service Area, 2009

3,234,680

Percentage of Los
Angeles County
100%

90004

23,817

0.74%

90005

16,478

0.51%

90006

20,088

0.62%

90007

13,122

0.41%

90008

13,493

0.42%

90010

940

0.03%

90011

22,898

0.71%

90016

16,785

0.52%

90017

8,858

0.27%

90018

15,931

0.49%

90019

24,782

0.77%

90020

18,442

0.57%

90026

25,034

0.77%

90027

23,119

0.71%

90028

15,320

0.47%

90029

14,306

0.44%

90031

10,817

0.33%

90037

15,545

0.48%

90044

25,589

0.79%

90046

29,388

0.91%

90057

16,608

0.51%

371,360

11.48%

Number of Households
Los Angeles County
Zip Codes

Cumulative
Source: HealthyCity.org (Nielsen Claritas, Inc), 2009

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

2.7 Language Spoken at Home


In 2010, it was estimated that more than two thirds (69.1%) of the population in SVMCs primary service area spoke a language other than
English at home, a proportion much higher than Los Angeles County. Of the 21 zips codes in SVMCs primary service area, 51.5% of the
population spoke Spanish at home, 30.9% spoke English at home, 11.9% spoke an Asian or Pacific Islander language at home, and 5.7% spoke
Other languages at home.
Figure 10. Percentage of Languages Spoken at Home in SVMCs Primary Service Area, 2009

Source: Nielsen Claritas, Inc., 2009

2.8 Marital Status


In 2009, nearly three quarters of residents living within SVMCs primary service area reported either having never being married (41.5%) or being
currently married with their spouse being present (35.1%). Similar results were seen overall for Los Angeles County residents; however
categories were reversed with 33.7% reporting never being married or 44.3% being currently married with their spouse being present. The
remainder of the population within SVMCs primary service area reported being currently married with their spouse being absent (10.9%), being
divorced (7.2%), or widowed (5.3%). Please see Figure 11 for more data.

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Figure 11. Percentage of Individuals Maarried, Never Maarried, Divorced or Widowed in SVMCs Primary Service Area, 200
09
Los Angeles County

SVMC Seervice Area

50%

44.3%

40%

41.5%
35.1%

33.7%

30%
20%
10%

8..1%
6.2%

7.2%

7.7%

10.9%

5.3%

0%
dowed
Wid

Divorced

Source: Nielsen Claaritas, Inc. 2009

Now married, spousee Now married, spouse


absent
present

Never maarried

2.9 Foster Care Population


In 2008, 1% of the 10,191 children
n who entered fo
oster care in Los Angeles County overall were from SVMCs primary service area. Mo
ost foster
youth entering caare were from zip
p codes 90044 (27
75), 90011 (194),, and 90037 (108)). Please see Figu
ure 12 for detaileed data.
Figure 12. Fostter Care Populatiion* in SVMCs Primary Service Area, 2008
Zip Co
ode
9000
04
9000
05
9000
06
9000
07
9000
08
9001
10
9001
11
9001
16
Service Are
ea
Los Angeless County

Num
mber of children
entering Foster Care
35
16
23
25
62
0
194
49
1054
10, 191

Zip Code
90017
90018
90019
90020
90026
90027
90028

Number of children
entering Foster Care
24
4
55
49
14
4
44
4
7
9

Zip Code
90029
90031
90037
90044
90046
90057
90020

Number of child
dren
entering Foster Care
17
26
108
275
3
19
14

Source: Department of Children & Family Seervices, 2008

* The number of children entering thee foster care system rep


presents an unduplicateed count of all children entering foster care in 2008.

32

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

In 2008, there was a total of 141,882 Department of Children and Family Services (DCFS) child abuse referrals in Los Angeles County. In SVMCs
primary service area there was a total of 19,651 DCFS child abuse allegation referrals. Most referrals were from zip codes 90044 (3,683), 90011
(2,301), and 90037 (2,094). Please see Figure 13 for detailed data by SVMCs primary service area zip codes.
Figure 13. Child Abuse Allegation Referrals in SVMCs Primary Service Area by Zip Code, 2008
Zip Code
90004
90005
90006
90007
90008
90010
90011
Service Area
Los Angeles County

Referrals
829
355
1,157
597
912
40
2,301
19,651
141,882

Zip Code
90016
90017
90018
90019
90020
90026
90027

Referrals
921
550
966
974
327
1,100
227

Zip Code
90028
90029
90031
90037
90044
90046
90057

Referrals
238
477
806
2,094
3,683
146
951

Source: Department of Children & Family Services, 2008

Within the same year, 1,084 children within SVMCs primary service area were removed from the home as a result of DCFS child abuse allegation
referrals. Most DCFS removals were from zip codes 90044 (286), 90011 (160), and 90037 (119). Figure 14 has detailed data by SVMCs primary
service area zip codes.
Figure 14. DCFS Removals in SVMCs Primary Service Area by Zip Code, 2008
Zip Code
90004
90005
90006
90007
90008
90010
90011
Service Area
Los Angeles County

Removals
34
13
42
32
54
1
160
1,084
N/A

Zip Code
90016
90017
90018
90019
90020
90026
90027

Removals
51
30
69
37
20
45
6

Zip Code
90028
90029
90031
90037
90044
90046
90057

Removals
5
15
24
119
286
3
38

Source: Department of Children & Family Services, 2008

33

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Overall, few interview participants discussed foster youth. However, those that did discussed placement of foster youth. More specifically,
foster youth who went to an emergency room without a placement ended up spending hours waiting in the ER.
2.10 Poverty Rate
In 2010, there were 2,226,818 families living in Los Angeles County, of which 12.4% (275,280) were living below the federal poverty level
(Nielsen Claritas, Inc., 2010). Compared to California (9.8%) and Los Angeles County (12.4%), SVMC service area had a larger percentage (23.0%)
of families living below the federal poverty level. The two SVMC primary service area zip codes that report the highest percentage of families
living below poverty are 90017, at 36.6% (2,016) and 90037, at 32.6% (3,833) of families living below poverty. However, more than half of the
primary service area zip codes are below Los Angeles County poverty rate (12.4%). Percentage data for families living at or above poverty are
detailed in Figure 16.

34

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 15. Percentage of Families Living Below the Federal Poverty Level in SVMCs Primary Service Area, 2010

Source: Nielsen Claritas, Inc., 2010

35

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 16. Percentage of Families Living At or Above the Federal Poverty Level in SVMCs Primary Service Area, 2010

Source: Nielsen Claritas, Inc., 2010

36

Los Angeles Metrop


politan Hospital Co
ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

Broken down at the SPA level, fo


our out of the seeven Metro Collaaborative SPAs were below Los Angeles Countyss poverty percenttage rate of
12.4% SPAs 2, 3, 5, and 7. SPA 4 and 6, which are located withiin SVMCs primarry service area, had the highest rates of families living below
poverty (19.7% and 24.7% respecttively), and also have rates higherr than Los Angeles County.
Figure 17. Families Living Be
elow or At/Above
e Poverty by SPA
A, 2010
% Families Below Poverty
Los Angeles County
Servvice Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
Wesst (5)
Soutth (6)
East (7)
Soutth Bay (8)

% Famiilies At/Above

N
275,280

%
12
2.4%

N
1,951,53
38

%
87.6%

44,340
37,517
48,304
8,859
47,682
32,617
43,974

9.1%
9.0%
9.7%
19
6.2%
24
4.7%
1.2%
11
12
2.7%

442,147
7
4
377,824
196,423
3
133,228
8
145,397
7
258,203
3
301,591
1

90.9%
91.0%
80.3%
93.8%
75.3%
88.8%
87.3%

Sourcce: Nielsen Claritas, Inc, 2010

2.11 Household Income (Median)


In 2009, a mediaan household inccome of $55,499
9 was reported for Los Angeles County (U.S. Cen
nsus, 2010). Thatt number is high
her than the
median householld income of all households within
n the SVMC primary service area, with incomes ran
nging between $17,861 and $48,5
587. The zip
codes with the lo
owest reported ho
ousehold incomees were 90014 ($9,999) and 90013
3 ($10,717). The zip codes with th
he lowest median
n household
income were 900
071 ($17,861) and 90015 ($22,152). Similar to the last report con
nducted in 2007, the median household income of the Metro
Collaborative prim
mary service areaa continues to ran
nk below the Cou
unty average.

37

Los Angeles Metrop


politan Hospital Co
ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

Figure 18. Mediaan Household Income in SVMCs Primary Service Area, 2009
Los Angeles County

$55
5,499.00

Service Zip Code 90046

$48,587.00

Service Zip Code 90027

$40,571.00

Service Zip Code 90015

$22,152.00

Service Zip Code 90071

$17,861.00
0

10000

20
0000

30000

40000

50000

60000

Source: Nielsen Clarittas, Inc. 2009


des represent the highest and lowest median housohold incomes with
hin the primary and seccondary service areas of SVMC.
Note: Service zip cod

2.12 Class of Worrkers by Industry


According to 201
10 estimates, claass of workers by industry in Loss Angeles County consisted of 3,124,251 for pro
ofit private workers (72.5%),
254,030 non proffit private workers (5.9%), 348,43
36 local governmeent workers (8.1%
%), 108,562 statee government wo
orkers (2.5%), 61,243 federal
government workkers (1.4%), 401,5
516 self employeed workers (9.3%), and 9,093 unpaaid family workerrs (0.2%).
2.13 Employmentt Status, Including Unemployment
In the SVMCs prrimary service arrea, about 49.7%
% of the populatio
on was employed in 2009, much
h lower that the rate for Los Anggeles County
(55.4%). The une
employment ratee for SVMCs prim
mary service area is higher (6.6%) than Los Angeless County (5.0%). All but 3 out of 21 zip codes
(90027, 90046, and 90010) had higher percentagees of unemployed
d individuals than Los Angeles Co
ounty overall. Th
he zip codes with the highest
percentage of un
nemployment weere 90037 (8.8%),, 90018 (7.7%), 90044 (7.6%), 900
028 (7.5%), 90006 & 90007 (both at 7.2%), and 90
0026 (7.1%).
In SVMCs primaary service area, the percentage of individuals not in the labor force is higher than for Los Anggeles County oveerall (43.7%
compared to 39.5
5%). The zip codes with the higheest percentages of individuals nott in the labor forcce were 90044 (4
48.7%), 90011 (48
8.4%) 90031
(48.3%) and 9000
07 & 90037 (both
h at 48.2%). Pleasse see Figure 19 for data by zip co
ode.

38

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 19. Percentage Employment Status in SVMCs Primary Service Area, 2009
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Service Area
Los Angeles County

Civilian, Employed
N
%
29007
53.3%
17674
49.6%
24162
48.7%
16675
44.5%
12396
50.3%
906
49.9%
35509
44.8%
18051
48.7%
9914
48.4%
17365
45.9%
28949
52.6%
19915
53.9%
30339
52.5%
24121
55.1%
14004
53.0%
16330
47.6%
13897
46.4%
18268
42.9%
28222
43.7%
30042
63.3%
18558
49.3%
422,304
49.7%
4,278,222
55.4%

Civilian, Unemployed
N
%
3344
6.2%
2161
6.1%
3577
7.2%
2705
7.2%
1670
6.8%
62
3.4%
5061
6.8%
2293
6.2%
1218
5.6%
2913
7.7%
3449
6.3%
2014
5.6%
4118
7.1%
2211
5.0%
1985
7.5%
2070
6.0%
1601
5.4%
3739
8.8%
4909
7.6%
2221
4.7%
2438
6.5%
55759
6.6%
387,741
5.0%

Not in Labor Force*


N
%
22054
40.5%
15788
44.3%
21857
44.1%
18050
48.2%
10552
42.9%
848
46.7%
36232
48.4%
16706
45.1%
9284
45.4%
17484
46.3%
22633
41.1%
14978
40.6%
23289
40.3%
17412
39.8%
10451
39.5%
15855
46.2%
14454
48.3%
20500
48.2%
31431
48.7%
15174
32.0%
16624
44.1%
371,656
43.7%
3,058,848
39.5%

Source: Neilson Claritas, Inc., 2009


Note: Bolded numbers indicate zip codes with higher percentage than Los Angeles County overall of unemployed civilians
*Not in Labor Force are those who have no job and are not looking for one. Many who are not in the labor force are going to school or are
retired. Family responsibilities keep others out of the labor force.

SPA data reveal that those SPAs within SVMCs primary service area have a somewhat higher percentage of unemployment than Los Angeles
County, SPA 4 with 5.3% and SPA 6 with 6.6%, compared to Los Angeles County (4.4%). As would be expected, the rates for employed
individuals are lower compared to Los Angeles County. Also, the rates for individuals not in the labor force were also higher (SPA 4 with 37.5 %
and SPA 6 with 42.8%), compared to Los Angeles County (34.9%). Please see Figure 20 for more data.

39

Los Angeles Metrop


politan Hospital Co
ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

Figure 20. Percenttage Employmentt Status by SPA, 2010


A
Armed
Forces

Civiliaan Employed

Civilian Unemployed
U

Not in Labo
or Force

SService Planning Area


A
S Fernando (2)
San

500

0.03%

1,063,293

64.3%

64,711

3.9%

524,733

31.7%

S Gabriel (3)
San

427

0.03%

880,001

61.4%

52,515

3.7%

500,872

34.9%

M
Metro
(4)

218

0.02%

546,127

57.2%

50,828

5.3%

357,648

37.5%

W (5)
West

177

0.03%

379,538

67.8%

19,696

3.5%

160,663

28.7%

S
South
(6)

185

0.03%

351,541

50.5%

46,064

6.6%

297,855

42.8%

E (7)
East

507

0.05%

578,650

58.7%

41,079

4.2%

365,976

37.1%

S
South
Bay (8)

912

0.08%

718,150

61.8%

50,464

4.3%

392,717

33.8%

4,273
3

0.05%

4,720,096

60.7%

342,835

4.4%

2,715,069

34.9%

L Angeles Countyy
Los
Source: Nielsen Claritass, 2010

2.14 Means of Transportation to Work


According to 201
10 Nielsen Claritaas estimates for Los Angeles Coun
nty, 4.3% (181,49
94) worked at ho
ome which is sligghtly higher than the 3.5% in
2000. Less than 1% (0.8%, 119,58
86) walk to workk compared to 2.9% in 2000. Closse to one percen
nt (0.7%, 29,324) used bicycles ass a means to
get to work, com
mpared to 0.6% in 2000, which was slightly low
wer. Slightly low
wer than in 2000
0 (15.2%), there were 11.6% (48
88,764) who
carpooled to work. There was also a very slightt increase from 2000 (70.2%) to 2010 estimates for those that drove alone to work (71.7%,
3,013,544). Simillarly, 2010 estimaates state that 7.4% (309,446) usee public transportation to get to work. Lastly, 1.5%
% (61,815) used other means
to get to work, co
ompared to 0.8%
% in 2000.

3. Natality
3.1 Prenatal Care
e
The Healthy People 2010 objective is that at least 90% of motheers receive prenaatal care in the first trimester. From 2005 to200
06, 87.3% of
pregnant women
n in Los Angeles County began preenatal care in thee first trimester. However, a slighttly smaller percentage of uninsured pregnant
women (85.8%) are Hispanic/Latin
na and born in th
he United States (83.9%), living below the federal poverty level (83.6%), or are Medii Cal insured
(83.5%) began prrenatal care in their first trimester. An even smalller percentage off pregnant womeen who completeed some high school (79.8%),
were between th
he age of 15 and 19 (78.2%), or livving at home in which an Asian lan
nguage is primarily spoken (75.5%
%) began prenataal care in the
first trimester.

40

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

3.2 Birth Weight


Low birth weight is one of the leading causes of infant illness or death in a babys first year. In addition to higher costs for caring for premature
infants (25 times more); there are also potentially profound health and cognitive concerns as well. A baby born 5.5 pounds or less has an
increased chance of developing a vision, hearing, speech, neurological, sensory, or learning disability. In 2008, 6.8% of all live births in California
were of low birth weight; whereas, in Los Angeles County it was higher at 7.3%. Within GSH SPAs 4 and 6, most live births weighed less than 5.5
pounds (6.8% and 7.9%, respectively) or were of moderate low birth weight between 3.25 and 5.5 pounds (5.6% and 6.4%, respectively).
Overall, SPA 6 had the highest percentage of live births weighing less than 5.5 pounds.
Figure 21. Percentage of Live Births in Los Angeles County Service Planning Areas that are Very Low and Moderately Low Birth Weight, 2007
San Fernando
(2)

San Gabriel
(3)

Metro (4)

West (5)

South (6)

East (7)

South Bay
(8)

1.2%

1.3%

1.2%

1.2%

1.5%

1.2%

1.4%

6.2%

5.9%

5.6%

6.4%

6.4%

5.5%

6.3%

7.4%

7.2%

6.8%

7.6%

7.9%

6.8%

7.7%

Very Low Birth Weight


(<3.25 pounds)
Moderately Low Birth Weight
(3.25 5.5 pounds)
Total Low Birth Weight
(< 5.5 pounds)
Source: LA's Best Babies Network, Perinatal Scorecard 2010

Overall, in 2008 African Americans in Los Angeles County had the highest percentage of live births weighing below 5.5 pounds (13.5%).
Hispanics/Latinos and Pacific Islanders had the lowest percentage of live births weighing less than 5.5 pounds (6.4% and 6.5, respectively).
Figure 22. Percentage of Live Births that are Very Low and Moderately Low Birth Weight in each Racial/Ethnic Group, LA County, 2007 2008
Very Low Birth Weight (<3.25 pounds)
Los Angeles County
African American
American Indian/Alaskan Native
Asian
Hispanic/Latino
Pacific Islander
White

2007
Percentage
1.3%
2.9%
1.6%
1.1%
1.2%
1.0%
1.3%

2008
Percentage
1.2%
3.0%
1.8%
0.9%
1.1%
1.0%
1.2%

41

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

2007

2008

Moderately Low Birth Weight (3.25 5.5


pounds)
Los Angeles County

6.1%

6.1%

African American
American Indian/Alaskan Native
Asian
Hispanic/Latino
Pacific Islander
White

9.8%
10.5%
6.8%
5.4%
4.1%
6.4%

10.5%
7.1%
6.9%
5.3%
5.4%
6.6%

Total Low Birth Weight (< 5.5 pounds)


Los Angeles County

7.4%

7.3%

African American
American Indian/Alaskan Native
Asian
Hispanic/Latino
Pacific Islander
White

12.7%
12.0%
7.9%
6.6%
5.1%
7.6%

13.5%
8.8%
7.8%
6.4%
6.5%
7.8%

Source: LA's Best Babies Network, Perinatal Scorecard 2010

3.3 Births by Zip Code


In 2008, there were 139,679 births in Los Angeles County. In SVMCs primary service area, there were 17,397 births, 3.2% of births in Los
Angeles County. The majority of births occurred in zip codes 90011 (15.5%, 2,702), 90044 (11.2%, 1,942), 90037 (8.1%, 1,412), 90006 (6.0%,
1,037), and 90019 (5.9%, 1,025).

42

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 23. Number of Births in SVMCs Primary Service Area, 2008


Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
Service Area
Los Angeles County

No. of Births
971
600
1,037
530
457
16
2,702
770
456
853
1,025
17,394
139,679

Zip Code
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057

No. of Births
625
983
432
241
565
643
1,412
1,942
321
813

Source: California Department of Public Health (CDPH), 2008

3.4 Birth by Mothers Race/Ethnicity and Age


Overall, trends from the 2007 community needs assessment were similar to the 2010 community needs assessment.
Births by Mothers Race/Ethnicity. Ethnically, the majority of births were to Hispanic/Latina mothers (72.0%) within SVMCs primary service
area, much higher than the percentage in Los Angeles County (63.1%). Similarly, African American mothers within SVMCs primary service area
had a higher percentage of live births (11.6%) compared to the percentage in Los Angeles County (7.4%).

43

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 24. Percentage of Births by Mothers Race/Ethnicity in SVMCs Primary Service Area, 2008
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Service Area
Los Angeles County

African
American/Black
2.0%
2.5%
1.9%
13.2%
55.1%
0.0%
6.6%
27.7%
4.6%
21.6%
12.9%
2.9%
3.9%
2.6%
5.0%
2.7%
0.2%
14.5%
29.8%
3.1%
2.7%
11.6%
7.4%

Asian
20.2%
24.3%
9.5%
4.7%
1.8%
68.8%
0.2%
1.3%
5.3%
1.6%
13.1%
46.1%
8.9%
18.1%
8.7%
9.4%
18.0%
0.3%
0.2%
11.2%
13.8%
8.5%
11.1%

Hispanic/Latina
65.2%
68.5%
85.6%
78.1%
38.3%
6.3%
92.5%
64.8%
86.2%
72.3%
61.5%
44.5%
70.2%
30.3%
56.0%
77.4%
76.5%
83.5%
68.3%
10.0%
80.9%
72.0%
63.1%

Native American
or Alaskan
Native
0.0%
0.0%
0.0%
0.0%
0.2%
0.0%
0.0%
0.1%
0.0%
0.0%
0.0%
0.2%
0.0%
0.0%
0.4%
0.0%
0.3%
0.0%
0.2%
0.3%
0.0%
0.1%
0.1%

White
11.0%
3.3%
1.6%
1.5%
1.8%
18.8%
0.3%
3.8%
2.2%
2.7%
10.5%
4.8%
14.5%
46.3%
26.6%
8.9%
4.0%
0.6%
0.5%
72.6%
1.9%
6.4%
16.1%

Two or More
Races
1.2%
0.8%
0.3%
0.9%
1.5%
6.3%
0.2%
1.8%
0.9%
1.6%
1.4%
0.6%
1.6%
1.4%
0.8%
0.9%
0.2%
0.4%
0.7%
1.6%
0.5%
0.9%
1.4%

Other Race
0.4%
0.5%
1.0%
1.5%
1.3%
0.0%
0.3%
0.5%
0.9%
0.1%
0.7%
1.0%
1.0%
1.4%
2.5%
0.9%
0.8%
0.7%
0.3%
1.3%
0.3%
0.7%
0.8%

Source: California Department of Public Health (CDPH), 2008

In 2008 Hispanic women experienced births at a higher rate in SPA 4 (67.5%) and SPA 6 (77.8%), than in Los Angeles County (63.0%). African
American mothers gave birth at a higher rate in SPA 6 (19.2%) than in Los Angeles County (7.5%). In Spa 4, Asian (10.3%) and Filipino (3.1%)
mothers gave birth at a higher rate than in Los Angeles County (8.3% and 2.5%, respectively). Please see Figure 25 for more data.

44

Los Angeles Metrop


politan Hospital Co
ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

Figure 25. Births by Mo


others Race/Ethn
nicity by SPA, 200
08
Area
S Fernando SPA (2)
San
S Gabriel SPA (3))
San
M
Metro
SPA(4)
W SPA (5)
West
S
South
SPA (6)
E SPA (7)
East
S
South
Bay SPA (8)
L Angeles Countyy
Los

African
American/B
Black
2.7%
2.7%
3.0%
4.9%
19.2%
2.3%
14.3%
7.5%

Asian
6.0%
20.1%
10.3%
14.0%
0.42%
3.7%
8.5%
8.3%

Filipino
3.6%
2.6%
3.1%
1.5%
0.2%
2.1%
3.4%
2.5%

Hispanic
56
6.4%
60
0.3%
67
7.5%
20
0.4%
77
7.8%
83
3.0%
54
4.1%
63
3.0%

Native Am
merican/
Alaskan
n Native
0.11%
0.14
4%
0.07
7%
0.01%
0.02
2%
0.16
6%
0.12%
0.12%

Hawaiiian/Pacific
Islander
0
0.16%
0
0.14%
0
0.07%
0
0.23%
0
0.18%
0
0.24%
1
1.17%
0
0.32%

White
28
8.7%
12
2.1%
14
4.0%
53
3.1%
1..0%
7..4%
15
5.5%
16
6.2%

Two orr
More Racces
1.3%
1.4%
1.1%
3.2%
0.7%
0.8%
2.2%
1.4%

Other
Race
1.1%
0.60%
0.97%
2.78%
0.44%
0.30%
0.79%
0.80%

Source: California Department of Public Health


h (CDPH), 2008

Births by Age. Th
he percentage of births to motherrs age 20 or youn
nger (11.9%) is hiigher in SVMCs primary service area than that of Los Angeles
County (9.5%). More specifically, zip codes 90044 (16.5%), 90011 (1
16.0%), 90037 (14
4.7%), 90007 (13
3.4%), 90057 (13.0
0%), 90017 & 900
018 (both at
12.5%), 90006 (1
11.8%), 90008 (1
11.4%), 90026 (11.1%), 90031 (10
0.9%), 90029 (10
0.3%) and 90016
6 (9.9%) have higgher percentagess birthed by
younger motherss than Los Angelees County. Addittionally, the perccentage of births to mothers 20 to
o 29 years of agee is slightly higheer in SVMCs
primary service area (50.6%) than
n that of Los Anggeles County (48.8%). Just over half of zip codes in SVMCs primaary service area have higher
percentages of mothers 20 to 29 years of age than
n Los Angeles Cou
unty (48.8%). Pleease see Figure 26 for more data.

45

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 26. Birth by Mothers Age in SVMCs Primary Service Area, 2008
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Service Area
Los Angeles
County

Mother less
than 20 years
old
7.4%
7.8%
11.8%
13.4%
11.4%
0.0%
16.0%
9.9%
12.5%
12.5%
9.5%
5.9%
11.1%
2.8%
8.7%
10.3%
10.9%
14.7%
16.5%
1.6%
13.0%
11.9%
9.5%

Mother 20 29
years old
43.6%
47.0%
50.8%
51.3%
52.5%
56.3%
55.4%
54.0%
52.2%
55.3%
45.1%
43.4%
46.0%
34.7%
44.0%
51.9%
48.1%
55.3%
57.2%
24.0%
51.9%
50.6%
48.8%

Mother 30 34
24.6%
26.8%
21.8%
20.4%
19.9%
37.5%
17.6%
20.7%
22.4%
17.5%
26.4%
31.8%
22.8%
27.3%
24.1%
21.4%
23.8%
19.3%
15.0%
29.0%
21.9%
21.2%
24.0%

Mother 35
years and
older
24.4%
18.3%
15.6%
14.9%
16.2%
6.3%
11.0%
15.5%
12.9%
14.7%
19.0%
18.9%
20.1%
35.2%
23.2%
16.5%
17.3%
10.7%
11.3%
45.5%
13.2%
16.2%
17.6%

Source: California Department of Public Health (CDPH), 2008

In SPA 6, the percentage of mothers less than 20 years of age and mothers between 20 and 29 years of age (14.8% and 55.2%) was higher than
in Los Angeles County (9.7% and 47.0%, respectively). In SPA 4, mothers between 30 and 34 years of age and mothers 35 years of age of older
had higher percentages (24.8% and 20.8%) than in Los Angeles County (24.2% and 19.0%, respectively).

46

Los Angeles Metrop


politan Hospital Co
ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

Figure 27. Birtth by Mothers Age in SVMCs Primary Service Area, 2008
Area
San Fernando SP
PA (2)
San Gabriel SPA (3)
Metro SPA(4)
West SPA (5)
South SPA (6)
East SPA (7)
South Bay SPA (8)
Los Angeles Cou
unty

Mother lesss than


20 yearss old
7.4%
%
8.6%
%
9.3%
%
2.1%
%
14.8%
%
11.1%
%
9.7%
%
9.7%
%

Motherr 20 29
yearss old
44.8%
44.6%
45.1%
25.3
37%
55.2%
51.1
17%
46.6%
47.0
0%

Mother 30 34
26.9
9%
26.4
4%
24.8
8%
34.6
6%
17.9
9%
22.6
6%
24.0
0%
24.2
2%

Mother 35 years
and older
21.0%
20.4%
20.8%
37.9%
12.2%
15.1%
19.7%
19.0%

Source: California Deepartment of Public Heaalth (CDPH), 2008.

4. Mortality
4.1 Deaths
In 2008 there we
ere a total of 58,,028 deaths repo
orted in Los Angeeles County. Of those reported deaths, 5,569 (9.6%) occurred witthin SVMCs
primary service area (California Deepartment of Pub
blic Health, 2008). Across SVMCss primary service area the averagee number of deatths was 265,
however a signifiicant number of the deaths were reported within service zip code 90044 (%, 533), 90019 (%, 428), and 90018 (%, 413) (CDPH).
Please see Figure
e 29 for more data.

47

Los Angeles Metrop


politan Hospital Co
ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

Figure 28. Number of Death


hs in SVMCs Prim
mary Service Areaa, 2008
533
428

413

Service Zip Code 90


0019

Servicee Zip Code 90018

265

Average

Service Zip Code 90044

Source: California Department of Public Health (CDP


PH), 2008

In SPA 4, there were 6,121 deatths which accounted for 10.5% of the total num
mber of deaths in
n Los Angeles County. There were a smaller
number of death
hs in SPA 6 (5,397
7), which accountted for 9.3% of deaths in Los Angeeles County.
Figure 29. Totaal Number of Deaaths by SPA, 2008
Los Ange
eles County

Deaths
58,028

Percentage of Los
L Angeles Countyy
100%

Service Planning Area


San Fernaando (2)

11,811

0.4%
20

San Gabrriel (3)

10,563

8.2%
18

Metro (4
4)

6,121

0.5%
10

West (5)

4,156

7.2%

South (6))

5,397

9.3%

East (7)

7,066

2.2%
12

South Bay (8)

8,953

5.4%
15

Source: California Department of Public Health (CDPH), 2008

Deaths by Gender. In 2008, there were slightly mo


ore deaths amongg males (51.5%) than females (48.5%) in SVMCs primary service arrea. In most
of the zip codes in SVMCs servicees area, deaths arre nearly split bettween males and
d females. Howevver, there are tw
wo zip codes wherre deaths by

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

gender vary greatly. In zip code 90010, there were a larger percentage of deaths among females (66.7%, 10) and in zip code 90017 there were a
larger percentage of deaths among males (61.8%, 47).
Deaths by Age. Deaths reported by age were significantly higher among adults, age 85 and above (26.5%, 1,475) and those age 75 to 84 (22.9%,
1,275) in SVMCs primary service area (CDPH). Those percentages were slightly lower than Los Angeles County (30.5% and 25.8%, respectively).
However, those less than one year old experienced a higher number of deaths (97) than those 1 to 4 years of age (15) and those 5 to 14 years of
age (26).
Figure 30. Deaths by Age Group in SVMCs Primary Service Area, 2008
Age 85 and over

1,475

Age 75 to 84

1,275

Age 65 to 74

829

Age 55 to 64

786

Age 45 to 54

553

Age 35 to 44

248

Age 25 to 34

149

Age 15 to 24

116

Less than 1 year old


Age 5 to 14
Age 1 to 4

97
26
15

Note: The number of deaths are for the SVMC primary service area.
Source: California Department of Public Health (CDPH), 2008

Please note that the United States has one of the highest infant mortality rates of all developed countries. The leading causes of infant mortality
are birth defects, preterm birth/low birth weight, Sudden Infant Death Syndrome, maternal complications during pregnancy, and complications
affecting newborns due to the placenta, cord or membrane. Since 1980, California has had lower infant mortality rates than the rest of the
nation. For 2003 and 2004 Californias rate was 5.2 per 1,000 live births. In 2007, it was 5.3 per 1,000 for Los Angeles County. Infant mortality

49

Los Angeles Metrop


politan Hospital Co
ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

rates among African Americans (10.7 per 1,000) were more than twice as high co
ompared to otheer ethnicities. SP
PAs 2, 3, 6, and 8 either had
equivalent or higher rates than Lo
os Angeles Countyy as a whole.
4.2 Cause of Deatth
The top two causses of death repo
orted for SVMCs primary service area were heart disease (28.9%, 1,609) and canceer (22.1%, 1,231)) (CDPH). In
the 2007 commu
unity needs assesssment, heart dissease and cancer were also the most common caauses of death. Other causes acccounted for
17.7% (988) of de
eaths, followed by strokes (6.5%, 363), diabetes (3
3.9%, 218), influeenza and pneumo
onia (3.9%, 216) unintentional injjuries (3.9%,
215), and chronicc lower respiratorry disease (3.8%, 212). Please see Figure 31 for mo
ore data.

Figure 31. Cause of Death in SVMCs Primaary Service Area, 2008


Diseaases of the Heart

1,609

Malignant Neo
oplasms (Cancer)

1,231

All Other Causes

988

Cerebrovascular Disease (Stroke)

363

Diabetes Mellitus

218

Influenza and Pneumonia

216

Unintentional Injuries

215

Chronic Lower Respiratory Disease

212

Alzh
heimer's Disease

133
115

Chron
nic Liver Disease

112

Nephritis, Nephrotic Syndrome and Nephrosis

80

Intentional Self Harm (Suicide)

77
Source: California Departmentt of Public Health (CDPH
H), 2008

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

4.3 Premature Death


Understanding the reasons why people die prematurely is important in order to better understand the health needs of the community. In 2006,
the life expectancy in Los Angeles County was 80.3 years of age3. In 2007, 24 out of every 100 premature deaths in Los Angeles County were
caused by coronary heart disease4. In Los Angeles County, leading cause of premature death in 2007 was also coronary heart disease (SPAs
2,3,4,5,7), and homicide (SPA 6 only). In SVMCs primary service area, the leading causes of premature death in SPA 4 were coronary heart
disease and homicide (2007). In SPA 6, homicide was the number one cause of premature death followed by coronary heart disease (2007).
Similar trends were noted in the 2007 community needs assessment. Please see Figure 32 for other premature death data.
Figure 32. Ranking of Premature Death by SPA, 2007
Service Planning Area
San Gabriel
SPA 3
Coronary heart
disease
Motor vehicle
crash
Homicide

Metro
SPA 4
Coronary heart
disease
Homicide

West
SPA 5
Coronary heart
disease
Drug overdose

San Fernando SPA


2
Coronary heart
disease
Motor vehicle
crash
Suicide

Drug overdose

Suicide

Lung cancer

Lung cancer

Homicide

Suicide

HIV
Motor vehicle
crash

Lung cancer
Motor vehicle
crash

Rank
1
2

South
SPA 6
Homicide
Coronary heart
disease
Motor vehicle
crash
Stroke
Diabetes

East
SPA 7
Coronary heart
disease
Homicide

South Bay
SPA 8
Coronary heart
disease
Homicide

LA County
Coronary heart
disease
Homicide

Motor vehicle
crash
Liver disease

Motor vehicle
crash
Lung cancer

Motor vehicle
crash
Drug overdose

Stroke

Drug overdose

Liver disease

Source: 2007 Los Angeles County Public Health: Mortality in Los Angeles County

3
4

County of Los Angeles Department of Public Health, Life Expectancy in Los Angeles County: How long do we live and why? A Cities and Communities Health Report
Los Angeles County Public Health: Mortality in Los Angeles County

51

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

B.

ACCESS

1. Health Insurance
Despite the passage of health care reform legislation, many components of which have not taken effect, many focus group and interview
participants reported seeing more and more people losing health insurance. Some of this has to do with high unemployment rate, as many
people have lost their insurance coverage when they were laid off. Health insurance is a particular problem for immigrants who are
undocumented, who would not quality for public insurance programs, or who are small business owners. For instance, a high percentage of
Koreans are uninsured. One participant explained, Many are undocumented, but we also have a large small business population. They make
too much money to get government benefits like Medi Cal, but they cannot afford their own insurance. They fall into that limbo area. Another
participant reported seeing many blended families, where the children are eligible for public programs but the adults remain uninsured. She
added, We find that adults put off services for themselves. Theyre afraid they would go in and get charged for services they cant afford.
1.1 Type and Status
In 2009, the Medi Cal beneficiary rate for Los Angeles County was 232.8 per 1,000 people (up from 228.1 in 2008), higher than of California
(188.0 per 1,000 people) (Healthy City). In 2008, the Healthy Kids enrollment rate for Los Angeles County was reported at 12.5 per 1,000
children, and in 2010, there were 522,363 WIC participants in Los Angeles County. However, in 2007 19.2% of adults 18 and over in Los Angeles
County did not have a regular source of care and 11.8% could not afford to see a doctor.
According to the California Health Interview Survey (CHIS), between 2003 and 2005, all but 3 of the 21 zip codes in SVMCs primary service area
had an uninsured rate above 20% of more among population ages 0 to 64. The zip codes with the highest rates of uninsured were 90017
(33.7%), 90006 (30.5%), 90057 (30.2%), 90005 (29.1%), 90029 (28.3%), 90011 (28.0%), 90031 27.5%), 90004 (26.8%), 90007 (26.8%), 90026
(26.6%), and 90037 (25.5%). In zip code 90017, about 1 in 3 people were uninsured. Please see Figure 33 for more details.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 33. Percentage of Population without Health Insurance Coverage in SVMCs Primary Service Area, 2007
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018

Percentage of Population Ages 0 64


Without Health Insurance Coverage
26.8%
29.1%
30.5%
26.8%
16.2%
22.9%
28.0%
20.1%
33.7%
22.7%

Zip Code
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057

Percentage of Population Ages 0


64 Without Health Insurance
Coverage
24.3%
26.6%
19.7%
24.3%
28.3%
27.5%
25.5%
22.2%
16.0%
30.2%

Source: CHIS 2003 2005

1.2 Healthy Families Disenrollment


California Healthy Families Program is a sponsored low cost insurance program for children, teens, and pregnant mothers. Benefits include
health, dental and vision coverage for children who do not have insurance and do not qualify for no cost Medi Cal. Health access includes visits
to medical doctors, specialists and eye doctors. Participating providers include community based clinics, laboratories, pharmacies and hospitals.
As of December 2009, statewide Healthy Families subscribers totaled 882,434 members. The majority of subscribers are Latino/Hispanic (51.6%),
followed by Other (23%), Asian/Pacific Islander (10.1%), White (9.6%), and African American (1.9%). Subscribers either speak English (47.2%),
Spanish (44.3%), or Asian (6.3%). Nearly half of the subscribers are male (51.4%) and 48.6% are female.
Healthy Families long term retention data indicated a high rate of those remaining enrolled longer than a year during the economic boom
between 2004 and 2007. However, disenrollment numbers have increased. From January through December 2008, 27% of families in California
disenrolled from Health Families after one year. Of those 27%, the most common reasons for disenrollment were non payment of premiums
(11%) and required documentation were not provided (8%). In 2009 there were over 83,000 subscribers who disenrolled from the program in
Los Angeles County, accounting for a 37% drop in subscribers. According to Healthy Families (2008), non payment disenrollment has increased
in 2008 for a couple of reasons: the economic downturn and Healthy Families premium increase. However, there are other reasons for
disenrollment that include: child aging out of the program, failure in meeting income requirements, failure to submit citizenship/immigration
paperwork, enrollment change from Health Families to Medi Cal, or enrollment change from Healthy Families to employers insurance.

53

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

2. Regular Source of Care


According to the Los Angeles County Community Health Survey, an average of 80.8% of adults reported having a regular source of care between
1999 and 2007. On average, both of SVMCs SPA percentages were lower compared to Los Angeles County (73.9% in SPA 4 and 76.7% in SPA 6).
In 2007, the percentage of adults who reported a regular source of care in SPA 4 slightly increased to 74.1% from 2005 (72.0%). In SPA 6, the
rate also increased to 79.1% from 2005 (73.1%). Please see Figure 34 for more detail.
Figure 34. Percentage of Adults (18+ years) Reported Having a Regular Source of Health Care by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

Percent
80.8%

2007
Estimated #
5,998,000

2005
Percent
80.2%

2002 03
Percent
81.4%

1999 00
Percent
81.6%

82.7%
81.0%
74.1%
81.3%
79.1%
80.6%
83.5%

1,305,000
1,112,000
692,000
426,000
536,000
764,000
964,000

80.1%
84.4%
72.0%
84.8%
73.1%
80.9%
83.0%

82.0%
81.7%
73.9%
82.8%
79.6%
81.8%
85.0%

82.9%
83.8%
75.7%
83.1%
75.0%
81.4%
84.0%

Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and
Epidemiology, LA County Department of Public Health

Focus group and interview participants discussed the decreasing availability of medical care and services as a result of the recession and budget
cuts. Some communities experienced hospital closure in their areas, and community organizations went bankrupt. Speaking specifically about
South Los Angeles, one participant noted that many private doctors who used to get referrals from hospitals that have since closed (including
MLK) had to relocate because they lost business without referrals. Also, because of the low Medi Cal reimbursement rate, many providers
refuse or have stopped taking patients with Medi Cal coverage. For this reason, participants emphasized that just because someone is insured,
it does not mean he or she has a regular source of care.
Focus group and interview participants stated that they continued to see people delaying medical care until their conditions or symptoms
became intolerable. One participant said that the only time some of their clients would go to the hospital is when the ambulance is ready to
pick them up, when theyre really, really sick. Emergency room continues to be the last resort for many community members who are

54

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

uninsured or who delay care. Having patients in ER whose symptoms do not warrant emergency care taxes the quality and efficiency of our
health care system.
2.1 DHS Use in the Past Year
Note: Data in this section has not been updated since the 2007 community needs assessment.
Although the rate of having a regular source of care has remained constant for Los Angeles County, the rate of receiving medical services from
Los Angeles County Health Department facilities has almost doubled from 1997 to 2005.
Figure 35. Percentage of Adults (18+ years) Reported Receiving Medical Services
from LA County Health Department Facilities in the Past Year by SPA, 2005

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2005
Percentage
17.4%
15.4%
15.7%
22.7%
8.8%
27.1%
17.6%
14.9%

Estimated #
1,248,000

1999 00
Percentage
11.4%

1997
Percentage
9.9%

235,000
206,000
206,000
45,000
176,000
164,000
167,000

9.8%
11.4%
14.8%
8.2%
17.2%
10.3%
10.7%

8.5%
8.6%
12.0%
9.3%
15.6%
9.1%
9.2%

Source: 2005, 1999 00 & 1997 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, Los Angeles County Department of Health Services

3. Specialty Care
In response to specialty access problems, community clinics and health centers have begun to slowly increase their specialty services to meet
the growing needs of their patients by developing productive and ongoing relationships with local, private specialists who are willing to accept
patients on a paid or pro bono basis and share specialty services amongst other clinics and health centers (California Health Care Foundation,
2009).
In fact, according to the 2007 Specialty Care Access Survey (2009), 61% of responding community clinics and health centers provided some
specialty services onsite, and more than a third of those offered three or more specialties. Because of the increase in on site specialty care,

55

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

clinics and health centers report more frequent and faster service provider delivery for patients with urgent needs and more frequent and faster
receipt of consultation reports compared to patients who were referred out for specialty care.
Overall, community clinics and health care centers need to provide a minimum level of data to identify continuing access gaps, ensure the
efficient use of resources and the fiscal health of the community clinics and health centers, and demonstrate improvements in access, or lack
thereof (2009). The Pacific Health Consulting Group advises providers to measure, monitor, and report on the following 12 items for internal
services and for services provided to specialty network partners (California Health Care Foundation, 2009).
Figure 36. Twelve Program Indicators to Measure, Monitor and Report
Wait times for specialty services, by type of service and by provider
No show rates, by type of service and provider
Percentage of visits in which patients arrive with necessary ancillary
services complete and results available for the specialists
Provider retention rate by specialty
Specialists reported satisfaction with clinic systems and staff support
Ratio of regular support staff to specialist

Reimbursement rates for each specialty for various types of services


Payer mix for each specialty
Referral patterns of primary care providers, in order to track over
and underutilization of specialists
Referral patterns for specialty services by type and payer mix from
clinic partners in shared services
Increased knowledge of primary care providers in each specialty area
Increased skill of primary care providers to expand their scope of
practice with specialty skills

Focus group and interview participants stated that specialty care is particularly lacking in their community. Dental care was often cited to be one
of the areas that is most in need since Denti Cal has been cut for adults recently. One participant estimated that about three times more people
dont have dental insurance than health insurance. He cited a recent study conducted by a colleague that showed a correlation between cuts of
Denti Cal and increase in emergency room visits attributed to different dental coding, which has more than doubled. He added that even
though children still have access to Denti Cal, there has always been a lack of dental providers for children. Another participant added that most
clinics do not offer dental care, even though a lot of primary care providers realize their clients need a more holistic provision of health care that
includes dental, vision, and mental health. One participant remarked that, as a last resort, people rely on word of mouth to find unlicensed
dentists in private homes or even garages: They call it garage dentistry or swap meet dentistry.
The hardship caused by economic downturn also exacerbates existing illnesses, as participants began to see more patients with multiple
diagnoses and symptoms that give rise to the need for specialists like neurologists and gastroenterologists. One participant said, When I was a
resident many years ago, subspecialty patients were 10 12%. Now theyre closer to 50%, representing 21 different subspecialties.
There is also disparity in access to specialty care, as it is particularly lacking in medically underserved areas. For instance, one participant stated
that there was no cardiologist in the South Los Angeles area, even though South L.A. has the worst CHD [coronary heart disease] rate in the

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

County. The lack of specialty care in some communities is one reason why some participants were concerned about the health care reform
legislation that was passed in 2010. One explained, We feel that managed care right now has to show they have the doctors in place before
you move a huge chunk of new enrollees into the program, especially given our history in South L.A. If you dont have the specialists there, that
causes a lot of havoc on a persons continuity of care.
3.1 Special Health Care Needs
In 2008, 2.9% (274,930) of children under the age of 18 in California had major disabilities (serious difficulty in at least one of four basic areas of
functioning: vision, hearing, ambulation, and cognition)5. Of those children, 2.8% (71,783) were in Los Angeles County. In 2010, there were a
total of 680,164 children in California enrolled in special education due special health care needs (SHCN)6. Of those children, 26.8% (182,597)
were in Los Angeles County.
In 2010, a large percentage of children enrolled in special education in schools was Hispanic/Latino (48.3% in California and 61.3% in Los Angeles
County). A larger percentage of African American children in Los Angeles County (14.0%) are enrolled in special education than in California
overall (11.1%). However, a smaller percentage of Caucasian children in Los Angeles County are enrolled (18.9%) than in California (33.0%).
Figure 37. Percentage of Children Enrolled in Special Education, 2008
Ethnicity
African American/Black
Asian American
Caucasian/White
Filipino
Hispanic/Latino
Native American or Alaskan Native
Pacific Islander

California
11.1%
4.6%
33.0%
1.6%
48.3%
0.9%
0.5%

Los Angeles
County
14.0%
3.8%
18.9%
1.3%
61.3%
0.4%
0.3%

Source: Special Tabulation by the State of California, Department of Education, Special Education
Division; Assessment, Evaluation and Support.

U.S. Census Bureau, American Community Survey


According to kidsdata.org Children with special health care needs are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional
condition and who also require health and related services of a type or amount beyond that required by children generally.

57

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

4. Emergency Room Use


From 2008 to 2010, Los Angeles County experienced a decline in hospital diversions to 911 traffic (13.2% in 2008, 10.2% in 2009, to 10.1% 2010).
However, SPA 4 was the only SPA who experienced an increase from 2008 to 2010. SPA 6 had a small decrease in traffic from 2008 to 2010 (see
Figure 39). As noted in the 2007 community needs assessment, the increase in ER use could increase the cost burden of the provider hospitals
and decrease the service quality provided to clients (California Healthcare Foundation, 2006).
Figure 38. Percentage of Hospital Diversion to 911 Traffic Due to Emergency Department Saturation
in SVMCs Primary Service Area, 2010

Source: 2008 10 Diversion Report, Los Angeles County Health Services

Figure 39. Percentage of Hospital Diversion to 911 Traffic Due to Emergency Department Saturation by SPA, 2010

Los Angeles County


Region
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)

2010
Percentage
10.1%

2009
Percentage
10.8%

2008
Percentage
13.2%

10.0%
7.0%
16.0%
9.0%

11.0%
9.0%
14.0%
9.0%

15.0%
14.0%
12.0%
12.0%

58

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

South (6)
East (7)

2010
Percentage
8.5%
12.0%

2009
Percentage
10.2%
11.0%

2008
Percentage
10.9%
14.0%

Source: 2008 10 Diversion Report, Los Angeles County Health Services

4.1 Emergency Room Use for Children


The average number of children taken in for a trauma related emergency from 2000 to 2006 was 1,974 (10.9%) of all trauma cases. Since 2001,
the number of pediatric blunt or penetrating trauma cases (e.g. fall, motor accident, sports injury, burn, etc.) has declined (see Figure 40).
Figure 40. Los Angeles County EMS Agency Pediatric Trauma Hospital Volume, 2006

Source: Los Angeles County DHS, EMS TEMIS Report

59

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 41. Los Angeles County EMS Agency Pediatric Trauma Hospital Volume, 2006
Pediatric
Cases
Los Angeles County, by Year
2000
2,063
2001
2,245
2002
2,156
2003
2,001
2004
1,891
2005
1,675
2006
1,787

% Pediatric
Cases

Total Number
of Cases

12.2%
11.9%
11.2%
11.0%
11.0%
9.5%
9.6%

16,912
18,837
19,196
18,150
17,134
17,680
18,632

Source: Los Angeles County DHS, EMS TEMIS Report

5. Barriers to Access
5.1 Difficulty in Accessing Care
In 2007, 27.3% of adult residents over 18 years of age in Los Angeles County reported that obtaining medical care across the County when
needed was either somewhat or very difficult. SPAs 4 and 6 had the highest percentage of residents (33.3% and 38.8%) who reported that
obtaining medical care when needed was either somewhat or very difficult. However, those percentages have decreased since 2005 for both
SPAs (37.8% and 43.9%).
Figure 42. Percentage of Adults (18+ years) Who Reported That Obtaining Medical Care Is Somewhat or Very Difficult by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Percentage
Estimated #
27.3%
1,965,000
21.8%
30.6%
33.3%
13.8%
38.8%
27.2%
25.7%

336,000
398,000
297,000
69,000
256,000
252,000
288,000

2005
Percentage
30.1%

2002 03
Percentage
27.9%

1999 00
Percentage
27.0%

29.1%
23.9%
37.8%
19.1%
43.9%
34.2%
26.2%

25.5%
27.0%
34.9%
18.9%
36.2%
28.7%
26.0%

25.8%
23.9%
31.7%
24.8%
39.7%
28.1%
23.0%

Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health

60

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Focus group and interview participants cited various barriers when accessing medical care. One key barrier to access is the lack of knowledge in
navigating through an extremely complicated health care system. Participants shared that some patients would turn away from services
because of long waiting time or cumbersome paperwork that asks for a lot of sensitive information (especially for those who dont speak or
write English proficiently). One participant also said that patients often disengage from services because they were given appointments 5 or 6
months from the time they are requested. Participants also believed that some providers, even if they were very good at providing treatment
services, lack the customer service skills necessary to build trust with the patients. One participant believed that patients are often given the
run around that they are unable or unprepared to move through the complicated bureaucracy. Some participants lamented that there are not
enough advocates who could help community members handle the bureaucracy and advocated more support for case management.
Another related challenge is the fluctuations in funding. Some programs come in and out of the community based on availability of funding.
Also, patients who were formerly eligible for a program may find themselves ineligible if there is a change in funding regulations. This makes it
harder to navigate an already very complicated system. Many community members who fail to access services will become disillusioned and
diminish any chances of future attempts at access. One participant said confidently that most of the barriers can be eliminated if social workers
are in place to coordinate care, especially when you have a population with high needs and limited resources. Case managers can be the ones
that bring different professionals together.
Participants also cautioned against equating having insurance with having access to care. One remarked, Insurance is not the end all in terms
of access. Cost is still an issue for those who are insured. Many providers do not take clients with Medi Cal because of its low reimbursement
rates. In many medically underserved areas, one participant said, even if you do have an insurance card, it doesnt mean youll get to see a
doctor or get your medical problem fixed, or even get an appointment, just because you dont have enough facilities and clinics in the area. For
this reason, many participants were concerned about the impact of the recent health care reform legislation and stated that these communities
need to increase their capacity so that they could meet the demands of the increase in the insured population.
Another challenge that deters the community from access services are limited or inflexible hours of operation. Especially for many patients who
toil in service and manufacturing industries (such as hotel, restaurant, and garment industries) as well as small business owners, it is not realistic
to wait hours at a time for medical services without some consequences to their employment or finances. One participant acknowledged that
some clinics and hospitals had extended their hours during the week, but she added, Expanded hours are great, but 24 hours are even better.
Another participant believed that for many working immigrants, weekend hours are preferable to any time during the work week.
Two participants who have served their respective community for more than 20 years cited that accessibility improved for a while but only to
have worsened in the last few years. The outcomes of having accessible and adequate services were apparent to one of the participants. She
attributed the reduction of breast and cervical cancer incidences in the Thai community she serves to many years of prevention services that are
no longer available. She also credited the development of the Asian Pacific Health Care Venture in the late 1990s as a lifesaver to that
community, which has many Thai speaking staff. However, she conceded that with budget cuts, even that clinic had to refer out a lot to other

61

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

providers who do not have the language capacity. Similarly, the other participant said that she was afraid things were going back to what it was
15 20 years ago because of the budget cuts.
However, both providers and patients from focus groups and interviews cited that access to care is not a problem when someone is aware of
local, low cost, culturally and linguistically competent services at clinics, community health centers, and nonprofit organizations. Participants
who were providers cited that they have developed trusting relationships based on many years of serving their communities as a reason why
community members would seek out and accept services from them, including prevention services.
5.2 5.6 Could Not Afford to See a Medical Doctor, Mental Health Care, Dental Care, Eyeglasses, or Medication (Rx)
In the 2007 community needs assessment, based on 2005 numbers, it was reported that competing priorities for financial resources are more
common among low income and uninsured, and require people to make difficult decisions in terms of prioritizing their basic needs, often
overlooking medical needs (Diamant, 2005).
In 2007, 11.8% of adult residents over 18 years of age in Los Angeles County were unable to see a medical doctor for a health problem in the
past year because they could not afford it. In SVMCs primary service area, SPAs 4 and 6 had the highest percentage of residents (16.1% and
18.6%) unable to see a medical doctor because they could not afford it. However, those percentages have decreased since 2005 for both SPAs
(21.3% and 22.2%).
Figure 43. Percentage of Adults (18+ years) Unable to See a Doctor in the Past Year Because They Could Not Afford It by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Percentage
Estimated #
11.8%
879,000
10.4%
10.2%
16.1%
8.6%
18.6%
11.8%
10.3%

164,000
140,000
148,000
45,000
127,000
113,000
120,000

2005
Percentage
15.6%

2002 03
Percentage
13.2%

1999 00
Percentage
13.5%

1997
Percentage
18.0%

14.6%
12.2%
21.3%
12.6%
22.2%
14.5%
14.7%

11.8%
11.3%
19.1%
9.9%
16.4%
13.6%
12.1%

11.6%
12.6%
19.0%
12.2%
16.2%
13.1%
11.7%

16.2%
17.5%
23.2%
15.8%
22.7%
18.4%
15.7%

Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health

In 2007, 5.9% of adult residents over 18 years of age in Los Angeles County were unable to obtain mental health care or counseling in the past
year because they could not afford it. In SVMCs primary service area, SPAs 4 and 6 have the highest percentage of residents who were unable

62

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

to obtain mental health services because they were unable to afford it (7.3% and 10.9%). However, those percentages have decreased since
2005 for both SPAs (9.1% and 12.0%).
Figure 44. Percentage of Adults (18+ years) Unable to Receive Mental Health Care or Counseling in the Past Year Because They Could Not
Afford It by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Percentage
Estimated #
5.9
441,000
5.5
5.6
7.3
3.5
10.9
4.4
5.9

87000
77000
68000
18000
74000
42000
68000

2005
Percentage
7.8

2002 03
Percentage
6.5

1999 00
Percentage
7.8

1997
Percentage
8.0

7.8
4.5
9.1
8.8
12.0
6.9
8.3

5.0
7.2
9.3
7.2
6.3
6.0
6.2

8.1
6.5
11.2
6.7
8.9
5.9
7.7

8.3
7.3
9.7
10.5
9.2
7.7
6.0

Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health

In 2007, 22.3% of adult residents over 18 years of age in Los Angeles County were unable to obtain dental care (including check ups) in the past
year because they could not afford it. In SVMCS primary service area in 2007, SPAs 4 and 6 have the highest percentage of residents (27.7% and
28.8%) who did not obtain dental care (including check ups) in the past year because they could not afford it. While those percentages have
decreased since 2005 for both SPAs (31.8% and 35.1%), they still remain the highest rates across the country.
Figure 45. Percentage of Adults (18+ years) Unable to Obtain Dental Care in the Past Year Because They Could Not Afford it by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Percentage
Estimated #
22.3%
1,655,000
20.4%
19.4%
27.7%
13.4%
28.8%
24.0%
22.1%

322,000
268,000
256,000
700,00
196,000
228,000
256,000

2005
Percentage
25.6%

2002 03
Percentage
23.5%

1999 00
Percentage
23.6%

1997
Percentage
26.5%

24.4%
20.0%
31.8%
20.3%
35.1%
26.7%
24.4%

21.2%
23.7%
29.1%
18.6%
27.0%
26.0%
21.0%

22.5%
21.4%
30.4%
21.1%
29.0%
23.6%
21.2%

25.7%
26.6%
30.5%
22.3%
32.6%
28.3%
21.4%

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health

Note: Updated data for Figure 45 is unavailable.


Figure 46. Percentage of Adults (18+ years) Unable to Obtain Eyeglasses in the Past Year Because They Could Not Afford It by SPA, 2005
2005
Los Angeles County
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

Percentage
14.3

Estimated #
1,041,000

2002 3
Percentage
13.3

1999 00
Percentage
12.5

1997
Percentage
15.4

13.4
12.0
15.7
8.8
22.0
13.9
15.0

207,000
159,000
144,000
47,000
145,000
130,000
170,000

10.1
13.4
18.3
10.1
14.5
14.9
12.9

12.1
10.7
14.7
11.4
16.3
13.3
10.9

15.3
15.5
16.5
13.2
17.5
15.5
14.8

Source: 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health

The cost of prescription medications continues to be a problem for low income, uninsured and under insured individuals and families. Despite
the creation the California Discount Prescription Drug Program7 in 2006 aimed at alleviating the burden of medication cost for individuals and
families that are low income, many are still going without their medication.
In 2007, 12.1% of adult residents over 18 years of age in Los Angeles County did not get prescription medication in the past year because they
could not afford it. SPAs 4 and 6 have the highest percentage of residents (13.7% and 18.7%) who did not get prescription medication in the
past year because they could not afford it. However, in 2005 these percentages were even higher (17.7% and 25.0%).

In California In 2006, Assembly Bill 2911 created the California Discount Prescription Drug Program to alleviate the cost burden of medications low income individuals and
families. Specifically, the bill reduces prescription drug prices from 40 to 60% of the retail price for generic and brand name drugs for individuals in families with incomes below
300% of the federal poverty level (in 2006 07, $29,400 for an individual and $60,000 for a family of four), to individuals with unreimbursed medical expenses and incomes below
the state median family income (in 2006 07, $68,310 for a family of four), and to eligible seniors whose medications are not covered by Medicare. Taken from: Governors
Budget Summary 2010 2011 Office of Statewide Health Planning and Development. Accessed 11/02/2007 at
http://www.ebudget.ca.gov/pdf/BudgetSummary/HealthandHumanServices.pdf.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 47. Percentage of Adults (18+ years) Who Did Not Get Prescription Medication in the Past Year Because They Could Not Afford It by
SPA, 2007
2007

Los Angeles County


San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2005

Percentage
12.1%

Estimated
#
901,000

Percentage
14.9%

9.7%
12.2%
13.7%
7.7%
18.7%
13.6%
10.9%

154,000
169,000
128,000
40,000
127,000
130,000
126,000

13.7%
11.8%
17.7%
8.1%
25.0%
15.4%
14.4%

2002 03

1999 00

1997

Percentage
13.2%

Percentage
12.6%

Percentage
15.9%

11.7%
12.1%
15.0%
10.2%
18.0%
15.2%
12.1%

10.6%
9.2%
18.1%
10.0%
15.6%
13.6%
12.2%

14.9%
15.6%
17.5%
14.2%
20.8%
17.3%
13.0%

Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health

The cost of medical care is a barrier that many focus group and interviews participants mentioned. One participant remarked that low income
immigrants wont access any service if they think its too expensive. Another participant stated that if theres anything that catches people
attention in the Latino community, its signs that say free or low cost. For many, especially undocumented immigrants, there is a lack of or
limited access to public insurance programs. One participant said that people are afraid to go to the doctors because they might be charged.
Since they cannot access all the medical services they need in one place, i.e. no medical home, providers are seeing that the uninsured
population has to cobble together a patchwork of services, where they jump from place to place not because they want to, but because they
have to. A participant cited a diabetic patient who had to go to one clinic for his medication, and another clinic for a retinal scan, and yet
another for podiatry. Consequently, communication among providers is key to the management of his chronic disease.
Even for those who are eligible and have obtained coverage, cost can be a factor, as insurance might not cover all the expenses. One participant
who worked in the Latino community stated, Managing their diabetes even when theyre provided with a glucometer to check their sugar is a
challenge because the strips are very expensive and are not covered by many health insurances. Some immigrants who have Medi Cal may
hesitate to use services until the conditions become too severe because, as some participants stated, they erroneously believe that using these
services would jeopardize their chances of naturalization down the line.
Because of the high cost of mainstream medical care, many Asian and Latino immigrants turn to traditional or folk medicine, such as herbs, for
treatment. Sometimes the medicine is prescribed by a traditional healer; other times, immigrants self medicate. One participant remarked that
cost is why the black market medicine is becoming more popular lately in immigrant communities. People would go to these stores and tell the

65

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

store what they want, and it is in the back shelf or something. Sometimes you can find tetracycline and antibiotic. Some immigrants also visit
their home countries for care. Participants discussed some Latino immigrants who would go across the border to see a doctor or get
prescription drugs because of their availability and accessibility. Even Asian immigrants would travel out of the country to get more affordable
care. One participant shared that there are Korean tour groups that would take community members to get a full body check up or a CAT scan
or MRI in a hospital in South Korea in lieu of getting services in the U.S.
5.7 Transportation Barrier
County data from the Los Angeles County Health Survey indicate that transportation problems that have kept patients from obtaining needed
medical care in the past year are on the decline. In fact, for Los Angeles County current 2007 rates have fallen to 2002 03 percentage rates
(7.4%). In SVMCs primary service area, SPAs 4 and 6 had the highest rate of residents who reported transportation problems kept them from
obtaining medical care in the past year (9.7% and 12.5%). However, these percentages have decreased significantly for both SPAs since 2005
(11.9% and 18.1%).
Figure 48. Percentage of Adults (18+ years) Who Reported Transportation Problems Kept Them from Obtaining Medical Care in the Past Year
by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Percentage
Estimated #
7.4%
551,000
6.15%
7.2%
9.7%
3.2%
12.5%
6.9%
6.2%

96,000
10,000
91,000
17,000
85,000
66,000
71,000

2005
Percentage
9.5%

2002 03
Percentage
7.4%

7.1%
7.2%
11.9%
4.3%
18.1%
9.6%
10.3%

5.7%
6.4%
9.4%
3.9%
11.6%
8.8%
7.0%

Source: 2007, 2005 and 2002 03 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County Department of Public Health

Many focus group and interview participants also identified transportation as a significant barrier to accessing services. Patients who rely on
buses are at the mercy of their schedule. One participant shared that some patients had missed their appointments because their bus was late.
It is not uncommon that people would travel more than an hour on public transportation to get to their appointments. Transportation is a
challenge for the elderly, many of whom do not drive or have trouble walking long distances. Transportation is also a barrier for families with
young children that is often correlated with childcare. Some participants cited examples of adults managing multiple children on a bus or

66

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

subway in order to make an appointment for themselves or for their children. However, many community members from a focus group, a
majority of whom rely on public transportation, stated that they would find ways to get to services if they find services they trust (i.e. culturally
and linguistically competent) and that are high quality.
5.8 Language Barrier
Closing the language and cultural gap is critical, as discordant language ability may lead to misunderstanding and inappropriate care (Diamant,
2005). In 2007, 15% of adult residents over 18 years of age in Los Angeles County who completed the Los Angeles Health Survey Interview in a
Non English Language reported difficulty talking to a doctor or health care professional because of a language barrier in the past year. As Figure
50 indicates, this is the lowest percentage since 1999. In SVMCs primary service area, SPAs 4 and 6 showed the highest percentages of residents
who reported difficulty talking to a doctor of health care professional because of a language barrier (20.4% and 18.7%). However, these
percentages have decreased for both SPAs since 2005 (22.9% and 24.9%).
Figure 49. Percentage of Adults (18+ years) Who Completed the Survey Interview in a Non English Language in the Past Year and Who Also
Reported Difficulty Talking to a Doctor or Health Care Professional Because of a Language Barrier by SPA, 2007

Los Angeles County


San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Percentage
Estimated #
15.1%
319,000
13.3%
11.0%
20.4%

43,000
50,000
81,000

18.7%
14.5%
13.9%

51,000
50,000
34,000

2005
Percentage
18.7%

2002 03
Percentage
19.3%

1999 00
Percentage
16.2%

17.3%
16.0%
22.9%
27.1%
24.9%
15.9%
13.5%

21.3%
17.8%
19.1%

17.0%
14.0%
16.0%
18.3%
16.0%
14.0%
22.0%

21.0%
17.3%
21.8%

Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health

Focus group and interview participants identified the lack of linguistic competence as a barrier to accessing services. According to one
participant, the Korean community is over 70% immigrant and over 50% English speaking. Monolingual Korean speaking population is not
comfortable going outside of their comfort zone. Some participants also distinguished cultural competence from linguistic competence. One
participant remarked, Mainstream organizations make the mistake of thinking theyre going to hire a Korean speaker and now Koreans will
come to them. It was suggested that organizations need to go out and build these relationships with immigrant communities (through
collaborating with organizations that are already serving these communities), instead of hiring bilingual staff and waiting for the communities to
go to them. Another participant gave an example of cultural incompetence (and why language is not enough): We have a Latina diabetic
67

Los Angeles Metrop


politan Hospital Co
ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

woman, and her provider is Spanish speaking but not Latino. The provider told heer not to eat tortillas because its white flour. And
d the doctor
couldnt Figure out why the womaan is non compliaant?
One participant remarked that, even though maany children of Asian immigrantss could speak En
nglish, many still found mainstream services
uninviting becausse there are still cultural issues. Another particip
pant explained, Language is a barrier also for children who begin to transition
from home langu
uage to English ass they enter the school system.
Undocumented im
mmigrants, particcularly in the Asiaan and Latino com
mmunities, have tremendous fearr of deportation because of their immigration
status. Participants believed thatt a provider cann
not build trust wiith these immigrants unless she or he can demon
nstrate cultural and linguistic
competence.

6. Senior Care
Californias adult population, 60 and older, continu
ues to significantly
increase in size an
nd need. From 1950 to 2000, thee proportion of
older adults incre
eased 194% (1.6M
M vs. 4.7M). This trend is expected
d
to continue at 128% from 2010 to
o 2050, when the number of adultts
60 and older will grow to 14.6M. In just over the next ten years, it is
projected that ad
dults 60 years and
d older will comprise nearly 20% of
Californias total population.

20.0

Figure 50. Californ


nia Population Age
e 60+ Growth Trend
ds (in
Millions), 2007
7

15.0

11.5

12.9

14.6

8.9

10.0
4.2

4.7

6.4

5.0
2.6 3..0
The California De
epartment of Agin
ng State Plan on Aging for 2009
1.6
6 2.0
2013 cites the inccreasing health and service needs for diverse groups
0.0
of older adults an
nd adults with dissabilities.8 Locallyy, for example,
195
50 1960 1970 198
80 1990 2000 20
010 2020 2030 20
040 2050
during 2007 and 2009, over half (5
53%), or an averaage of 574,000, of
Los Angeles Coun
ntys seniors 65 yeears and older were disabled due
A
to a physical, men
ntal, or emotionaal condition.9 Thiis is also
compounded with seniors worsen
ning health conditions. The Los Angeles County Heealth Survey of seenior health trends from 2005 to 2007
indicated that:

In 2007, 18.5% (89,000) of seniors 60 64 and 19.2% (199


9,000) of seniors 65 and older weere diagnosed with diabetes. In 2005, 18.4%
000) of seniors 65
5 and older weree diagnosed with diabetes.
(76,000) of seniors 60 64 and 18.3% (184,0
8

California Departme
ent of Aging, Californ
nia State Plan on Agin
ng, 2009 2013
The Regents of the University of Californ
nia, California Health
h Interview Survey (C
CHIS), 2011

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

In 2007, among those aged 60 64, 13.9% (67,000) and those aged 65 and over, 23.7% (246,000) had been diagnosed with heart disease.
Heart disease rates increased from 2005, where those aged 60 64, 13.3% (55,000) and those aged 65 and older, 22.1% (221,000) were
diagnosed with heart disease.
In 2007, among those aged 60 64, 52.3% (250,000) and those aged 65 and over, 51.6% (531,000) had been diagnosed with high
cholesterol. Two years earlier, cholesterol figures were lower by as much as 8% for seniors 60 64 and 4% for seniors over 65. In 2005,
44.3% (181,000) of seniors 60 64 and 47.9% (478,000) of seniors 65 and older were diagnosed with high cholesterol.
From 2005 to 2007, the overall percentage of seniors reporting poor health status declined by almost three percent (2.8%). However
when broken down by subgroup, a greater percentage of adults 60 64 self reported poor health and a smaller percentage of adults 65
and older self reported poor health from 2005 to 2007. In 2007, among those aged 60 64, 30.5% (147,000) indicated poor health status
and of those aged 65 and over, 29.5% (303,000) indicated poor health status. Compared to 2005, among those aged 60 64, 28.4%
(117,000) and those aged 65 and over, 32.2% (323,000) indicated poor health status.
Findings from the previous needs assessment cited that many needs for the majority of older adults and adults with disabilities in Los Angeles
County go unmet due to a lack of information regarding the availability of services and lack of information on how to access them (County of Los
Angeles Area Agency on Aging, 2005). Specifically, the Los Angeles Countys Area Agency on Aging 2005 2009 Plan found that a lack of service
coordination among an overly fragmented and often competitive long term care system contributes to this problem.10
During key informant focus group discussions in 2010, seniors were asked to talk about current health issues affecting their neighborhoods. In
general, seniors reported concerns about the down economy, coupled with rising health care costs and living expenses; limited dental and
specialty care; and insufficient access to cultural and linguistic services. The 2009 California Health Interview Survey (CHIS) data for Los Angeles
County reported that:
In 2009, 5.1% (55,000) of seniors aged 65 years and older delayed or did not seek medical care. Two years prior in 2007, during the
height of the economic downturn, 7.1% (74,000) of Los Angeles County seniors delayed medical care.
Additionally, the most available CHIS data reported that in 2003, 12.0% (1,032,000) of Los Angeles County seniors could not afford
needed dental care.
Seniors who participated in community focus groups, also shared that they are satisfied with several components of their senior care center and
view their center as a valuable resource that has positively impacted the health of the community. For instance, surveyed seniors enjoy the
centers diversity, great food, and reliable transportation.

10

County of Los Angeles Area Agency on Aging, 2007 08 Update, Draft: Pending Board Approval: Area Plan 2005 09 Future Focused Leadership: Building and Reinventing, June,
2007

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

In terms of staffing, seniors said they like the fact that staff are also reliable, caring, and very informative about senior health issues. As a matter
of fact, the nutritious food clients receive at their local senior center was a major reason why they attend because without the extra help from
the staff, seniors said they would experience problems in managing their diabetes and hypertension. Similar to community focus group findings,
CHIS data reported that:
In 2009, 94.0% (1,075,000) of Los Angeles County seniors over the age of 65 had a usual place to go for medical care or health advice.
Compared to 2005, the proportion of Los Angeles Countys seniors that had a usual place to go to when sick or for health advice was
higher at 97.4% (984,000).
Overall, to meet the health service needs in the community, seniors, as well as providers, expressed the need of hospitals to disseminate health
information, specifically, at local health care centers. Seniors also shared the need for hospitals to offer low cost, non emergency services to
limit expenses and non emergency use of emergency room services.
In 2009, nearly one in five (18.3%), or 197,000, seniors 65 years and older visited the emergency room in the past 12 months. This is
down 6.0% from 2007, where nearly one in four (24.1%), or 251,000, seniors required an emergency room visit (CHIS, 2011).
Specific to SVMCS primary service area:
In 2009, 4.0% (7,000) of seniors 65 and older delayed or did not get medical care while 6.4% (12,000) delayed care in 2007.
In 2009, 91.0% (185,000) of seniors over the age of 65 had a usual source care compared to 94.0% (174,000) in 2005.
2009 emergency room use levels for Los Angeles County were similar to SVMCs primary service area. In 2009, 19.0% (39,000) of seniors
used the emergency room while 22.0% (40,000) of seniors used the emergency room in 2007 (CHIS, 2011).

7. Community Clinics
Data from the previous needs assessment reported a total of 172 community clinic sites in Los Angeles County in 2003 that served 732,040
patients and conducted 2,197,121 service encounters (Office of Statewide Health Planning and Development, 2003). Since then, trend data
indicate a steady growth in the number of Los Angeles County clinics, patients, and encounters. Los Angeles County has seen its largest primary
clinic growth from 2003 to 2004, with an increase of 7.6% (13 clinics) in one year. Since then, the percentage of patients served has increased by
as much as 9.3% from 2005 to 2006.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 51. Primary Care Clinic Demographic & Utilization Information, Los Angeles County, 2007
Year
2003

Clinics
172

Patients Served
732,040

Service Encounters

2004

185

772,254

2,438,716

2005

184

837,654

2,601,051

2006

200

915,521

2,903,254

2007

202

941,774

2,986,103

2,197,121

Source: California Office of Statewide Health Planning and Development (OSHPD)

The number of selected procedures for health screenings, tests, and immunizations has been mixed. Mammogram screenings were previously
on a rise year over year from 2003 to 2006. However, mammogram screenings have dropped significantly in 2007. Pap smear trends were in
reverse. The number of pap smear procedures saw a decline early on from 2003 to 2004. Since 2005, the number of pap smear screenings is on
the rise. This pattern is also similar for HIV testing and vaccination procedures. Please see Figure 53 for detailed data of Los Angeles Countys
primary clinic medical procedures.
Figure 52. Primary Care Clinic Selected Procedural Information, Los Angeles County, 2007
Year

Mammogram

HIV Testing

Pap Smear

2003

23,768

33,718

114,691

Contraceptive
Management
40,713

2004

25,203

29,862

107,139

113,108

222,624

2005

40,472

30,903

119,643

78,184

274,468

2006

46,849

40,670

117,056

95,254

280,877

2007

28,391

57,377

125,774

92,151

325,078

Vaccinations
271,583

Source: California Office of Statewide Health Planning and Development (OSHPD)

One of five patient visits to a Los Angeles County primary clinic was covered through the Countys Public Private Partnership (PPP) Program, for
an average cost of $569,792 a year. 11 The PPP Program was created in 1997 and is a joint effort between the Los Angeles County Department of
Health Services and private, community based providers, or partners. The goal of this partnership is to provide quality cultural and linguistic
primary, dental, and specialty care services to low income and uninsured individuals not covered by other government or third party programs.
Figure 53 lists the total number of PPP providers by SPA.

11

California Office of Statewide Health Planning and Development (OSHPD), 2003 2007

71

Los Angeles Metrop


politan Hospital Co
ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

Figure 53. LA Coun


nty DHS and PPP
P Program Provid
ders Primary Care
e Clinic Selected Procedural Information by SPA, 2007
Service
e Planning Area
San Ferrnando (2)

Total Number of Providerrs


17

San Gabriel (3)

13

Metro (4)

38

West (5
5)

South (6)
(

20

East (7)

21

South Bay
B (8)

19

Source: Los Angeles County Dep


partment of Health Servvices,

The Community Clinic Association


n of Los Angeles County (CCALAC) is the largest reggional association of community and free clinics in California,
servicing over 700
0,000 patients a year across 123 clinic sites12. CCALAC operates primary care sites th
hroughout the Co
ounty and seeks ways to
increase access to
o quality, compreehensive primaryy medical, dental,, and mental health services, to th
he uninsured, und
derinsured, working poor,
high risk and vuln
nerable populatio
ons. Current budget cuts and Californias cash flow
w crisis have delayed clinic paymeents, resulting in numerous
program, staff, an
nd service cutbaccks, which have greatly impacted the neediest fam
milies, children and
d communities.133
Funding shortfallss, delayed paymeents, and the grow
wing low incomee under insured population, will exxacerbate the exiisting ongoing
disproportionate burden the average Los Angeles clinic faces in treating the uninsurred, and even mo
ore so for the aveerage CCALAC clin
nic. Data
from the June 2008 CCALAC Los Angeles County 33
30 Expansion Plan
nning Report sugggested that theree is a 7% (193,560
0) patient visit sh
hortage
across the Countyy for all clinic types.

8. Disability
The 2008 Americcan Community Survey estimated that 2.9% (274,9
930) of Californiaans under the agge of 18 were dissabled and 8.2% (1,872, 819)
aged 18 to 64 we
ere disabled and
d 39% (1,544,874
4) of the population over 64 yearrs of age were diisabled. Children
n under 5 were identified as
having a disabilityy for the Americaan Community Su
urvey if they repo
orted having a hearing or vision diffficulty. Children
n 5 to 14 with heaaring, vision,
cognitive, ambulaatory, or self caree difficulties weree reported as disabled. Individuals aged 15 and ovver with the sam
me difficulties as those aged 5

12

CCALAC Los Angeles County Profile 200


07: Community clinicc association of Los Angeles County from
m the 2007 OSHPD An
nnual Utilization Repo
ort of Primary Care Clinics_Extract
Date 1/2009 (rev. 11//2008)
13
CCALAC Press Confference 6.15.09, You
u Are Cutting Us: Clin
nic Providers and Patiients Decry Budget Cuts

72

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

to 14 or they had independent living limitations were classified as disabled.14 Nationally, Californias disability prevalence rate for adults 18 and
over was moderate compared to the rest of the country. Regionally, California is one of four western states with the lowest percentage of
disability occurrences, excluding Hawaii.15 State prevalence percentage rates by state are detailed in Figure 54 below.
Figure 54. Disability Percentage Prevalence by State, 2008

Source: Center for Disease Control and Prevention, Disability and Health, 2008

14
15

Kidsdata.org
Center for Disease Control and Prevention, Disability and Health, 2008

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

C.

HEALTH BEHAVIORS AND PREVENTIVE CARE

Focus group and interview participants felt that preventative care and having healthier behaviors were difficult for certain populations for a
variety of reasons, although many understood the importance of a healthy lifestyle. One interview participant lamented, our healthcare system
is not set up to be preventive in nature. It is very reactionary and set up to reward taking care of problems that pop up instead of paying for
preventive and health promoting services. Other focus group and interview participants shared a similar concern that, due to budget and
funding cuts, there had been even less emphasis on disease prevention and health education. One participant stated that recent public funding
streams for both primary and mental health care focus on trauma and demand more requirements individuals need to meet in order to be
seen. Some participants were already seeing the effects of this and its implication on the availability and cost effectiveness of medical services.
One explained, Patients are getting sicker and sicker and utilizing more resources, which in the end costs a lot more money to treat. Another
participant shared that this higher demand for services, coupled with under staffing due to budget cuts, has led to longer wait times, which
deter some in the community from seeking the care that they need, especially those who cannot easily take time off to see a doctor.
Participants who serve the Asian or Latino immigrant communities agreed that family is an important concept to incorporate in health
promotion. In the Latino community, participants expressed a need for programs that focus on family involvement because family can help
introduce and maintain better options, such as eating healthier. For the Asian families, parents are likely to be more mindful about seeking
care for themselves if the message emphasizes the importance of being there for their family, for their children to have fit and healthy parents
who are able to care for them until they become independent adults.
Suggestions to creating healthier communities were also shared by focus group and interview participants. Many participants believed that
community organizations can help hospital in disseminating health information and messages to their patients and members in local
communities because community organizations have the trust and linguistic and cultural competence in diverse communities that they serve.
Many community organizations have health educators who are playing this role already. Other community organizations build leadership
among their clients to help them disseminate healthy messages to the broader community. One of them explained, Our former clients are now
embedded within positions in the community, like parent representative on school board or promotora. Sometimes they refer people in the
community to us.
Different participants suggested that schools and clinics are natural partners in health promotion because of their access to patients, children
and families. Participants also suggested hospitals to work more with ethnic media to promote healthy messages (such as the family focused
ones suggested above) and access to prevention and treatment services. For instance, one participant, who had surveyed the Korean
community in Los Angeles a couple years ago, found that 70% of first generation respondents read the Korean language newspapers at least
twice a week. For certain sensitive topics, such as mental health, health providers need to work with the right messengers even if the message
is culturally sensitive. In addition to ethnic media, participants have suggested religious leaders who can incorporate health and reduce stigma
in their messages to their congregations. Churches, one participant added, are amazing places to connect to communities. For immigrant

74

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

communities, the some of the Consulates have also been an ally. Both the Mexican and Thai Consulates were mentioned as partners in
promoting healthy messages and resources to the community.

1. Childhood Immunization
The National Immunization Survey (NIS) has collected childhood immunization coverage since 1994. Coverage estimates for 2009 include
children born during January 2006 to July 2008 and focuses on the following vaccines: vaccine birth dose, Hepatitis A vaccine, pneumococcal
conjugate vaccine [PCV], and rotavirus vaccine for children aged 19 35 months. NIS data indicate that vaccination coverage increased in 2009
compared with 2008 for Hepatitis B birth dose (from 55.3% to 60.8%) and Hepatitis A (from 40.4% to 46.6%), but coverage for PCV ( 4 doses)
remained stable (80.4%). Full coverage for rotavirus vaccine was 43.9% among children born within 2 years of licensure (1). Coverage for
poliovirus (92.8%), measles, mumps, and rubella (MMR) (90.0%), Hepatitis B (92.4%), and varicella (VAR) (89.6%) vaccines continued to be at or
near the national health objective of 90%, although coverage for MMR and Hepatitis B vaccines decreased slightly in 2009. The percentage of
children who have not received any vaccines remained low (<1%). 16
Among racial and ethnic groups, for more recently recommended vaccines, the Center for Disease Control reported that:
PCV and rotavirus coverage was lower among black and multiracial children than among white children. Coverage for PCV also was lower
among Asian children.
Coverage for Hepatitis A was lower among black children and American Indian/Alaska Native children than among white children. Except
for rotavirus coverage among black children, these differences persisted after controlling for poverty status.
Hepatitis B birth dose coverage was higher among Hispanic children than among white children. For vaccines with longer standing
recommendations, differences were observed for diphtheria, tetanus toxoid, and cellular pertussis (DTaP) vaccine. Compared with
coverage among white children, coverage was lower for black children for 3 and 4 DTaP doses and lower for Hispanic children for 4
doses only. The difference in coverage between white and black children for 4 doses remained statistically significant after controlling for
poverty status.17
And coverage by poverty status also varied, the NIS survey summarizes that coverage for:
Hepatitis B birth dose was higher among children living below poverty level than for those living at or above poverty level (by 3.8
percentage points).

16
17

2009 National Immunization Survey, Center for Disease Control and Prevention
2009 National Immunization Survey, Center for Disease Control and Prevention

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Among children living below poverty level, coverage was lower for 4 doses of PCV (by 8.4 percentage points) and rotavirus vaccine (by 9.4
percentage points) than for other children. Among the longer standing recommendations, coverage for 4 doses of DTaP also was lower
(by 5.6 percentage points).18
At the local level, Los Angeles Countys coverage for MMR vaccines was below the state (88.9% vs. 89.8%) and this pattern was also seen with
PCV doses. Los Angeles County had a higher percentage of childhood vaccination coverage than the state with Hepatitis B and A; and rotavirus.
Figure 55, from the NIS, outlines vaccination coverage at the national, state and county levels.

Figure 55. Estimated Vaccination Coverage for Vaccination Series (modified)* and Selected Individual Vaccines Among Children Aged 19 35
Months, by State and Local Area National Immunization Survey, United States, 2009
MMR ( 1 doses)
State/Area

PCV ( 4 doses)

Hep B (birth)

Hep A ( 2 doses)

Rotavirus**

Vaccine series
(modified)

(95% CI)

(95% CI)

(95% CI)

(95% CI)

(95% CI)

(95% CI)

United States

90.0

(0.8)

80.4

(1.1)

60.8

(1.3)

46.6

(1.4)

43.9

(1.4)

70.5

(1.2)

California

89.8

(3.7)

79.8

(5.1)

49.8

(6.3)

51.5

(6.3)

43.9

(6.1)

72.2

(5.5)

Los Angeles County

88.9

(5.4)

79.4

(6.7)

51.5

(8.1)

51.7

(8.0)

51.5

(8.1)

73.5

(7.2)

Rest of state

90.1

(4.7)

79.9

(6.5)

49.1

(8.1)

51.5

(8.0)

41.1

(7.8)

71.7

(7.1)

Source CDC, NIS Survey, 2009


Abbreviations: CI = confidence interval; DTP/DT/DTaP = diphtheria, tetanus toxoids and pertussis vaccines, diphtheria and tetanus toxoids, and diphtheria, tetanus toxoids, and cellular pertussis
vaccine; HepB = hepatitis B vaccine; Hib = Haemophilus influenzae type b vaccine; MMR = measles, mumps, and rubella vaccine; PCV = pneumococcal conjugate vaccine.
* Includes 4 doses of DTP/DT/DTaP, 3 doses of poliovirus vaccine, 1 doses of any measles containing vaccine, 3 doses of HepB, 1 doses of varicella vaccine, and 4 doses of PCV; Hib vaccine is
excluded.
Children in the 2009 National Immunization Survey were born during January 2006 July 2008.
1 doses of HepB vaccine administered between birth and age 3 days.
2 doses hepatitis A vaccine and measured among children aged 19 35 months.
** 2 or 3 doses of rotavirus vaccine, depending on product type received ( 2 doses for Rotarix [RV1] and 3 doses for RotaTeq [RV5]).
The asymmetric CI of 3.1 10.0 is reported instead of the confidence width.

18

2009 National Immunization Survey, Center for Disease Control and Prevention

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

2. Influenza and Pneumonia Vaccinations Among Elderly Adults


According to the Los Angeles County Department of Health Services Survey the proportion of individuals in Los Angeles County that received the
flu shot in the past 12 months increased from 1.6% percent from 1999 to 2007. Nearly three fourths of the population (71.3%) received an
influenza vaccine in 2007 compared 69.7% in 1999. However, rates did decline from 2000 to 2002 and again from 2002 to 2005. Percentages
across SPA reveal a less positive story; barely half of residents (51.0%) in SPA 6, which is located in SVMCs primary service area, received an
influenza shot in 2007. This is a large improvement from 2005 where less than half reported receiving a shot (44.9%). The remaining SPAs had a
range similar to Los Angeles Countys level of 71.3%.
Figure 56. Percentage of Adults (65+ years) who Reported Receiving the Flu Shot in the Past 12 Months by SPA, 2007
2007
Los Angeles County
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2005

2002 03

Percentage
71.3%

Estimated #
737,000

Percentage
61.6%

Percentage
69.3%

77.6%
69.3%
72.4%
73.4%
51.0%
70.4%
73.7%

172,000
143,000
89,000
62,000
39,000
91,000
122,000

62.3%
62.7%
73.0%
62.0%
44.9%
64.5%
56.9%

73.0%
71.3%
68.4%
68.0%
49.5%
73.1%
71.9%

1999 00
Percentage
69.7%
73.7%
68.8%
69.0%
68.5%
54.2%
62.3%
80.2%

Sources: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health

In Los Angeles County, pneumonia vaccination rates have steadily increased every year from 1999 to 2007 (54.9% vs. 55.7% vs. 57.7% vs. 60.5%)
and over half of the population across each SPA reported ever having a pneumonia vaccination. SVMCS SPAs, SPA 4 (54.6%) and 6 (51.1%) were
below the Los Angeles County rate (60.5%).

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 57. Percentage of Adults (65+ years) Reported Ever Having a Pneumonia Vaccination by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

Percent
60.5%

2007
Estimated #
599,000

67.6%
54.1%
54.6%
71.5%
51.1%
56.6%
63.9%

146
105
63
58
38
70
101

2005
Percent
57.7%

2002 03
Percent
55.7%

1999 00
Percent
54.9%

61.0%
61.4%
51.4%
57.4%
49.5%
55.6%
57.1%

61.7%
56.5%
50.4%
54.6%
44.2%
56.1%
55.0%

58.6%
53.8%
46.6%
60.1%
46.8%
51.0%
60.6%

Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health

3. Cholesterol Screening
The largest reported chronic condition in Los Angeles County is high blood cholesterol. Data from the 2007 Los Angeles County Health survey
reported that 29% of residents suffer with this condition. Several years prior to 2007, the reported percentage was lower at 16.1%. SPA data
indicate similar trends. Both SPA 4 and 6 in SVMCs primary service area reported lower percentages of adults diagnosed with high blood
cholesterol (26.0% and 25.5%) than Los Angeles Countys estimate of 29.1%.
Figure 59. Percentage of Adults (18+ years) Diagnosed with High Blood Cholesterol by SPA, 2007
2007
Los Angeles County
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

Percentage
29.1%

Estimated #
2,154,000

2005
Percentage
23.7%

1999 00
Percentage
16.1%

29.1%
31.5%
26.0%
30.6%
25.5%
30.5%
29.6%

456,000
431,000
242,000
160,000
174,000
291,000
340,000

26.4%
23.0%
21.5%
21.8%
18.3%
27.1%
24.3%

18.0%
18.3%
15.3%
13.5%
11.0%
14.4%
17.2%

Source: 2007, 2005 and 1999 00 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County Department of Public Health

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

4. Dental Care
Created to address the oral health needs of underprivileged children in Los Angeles County, the Childrens Dental Health Project and its
collaborative members (including the USC and UCLA Schools of Dentistry) conducted the most comprehensive county wide, oral health
assessment of underprivileged children. This project was guided by several alarming facts from the 2000 Surgeon Generals Report which found
that not only is oral health key to overall health, but poor dental health has become a silent epidemic for underprivileged children: dental
decay has become the leading common childhood disease, dental decay is five time more common than asthma, and children of lower economic
social status have 12 timed as many activity restricted days per year because of dental related illnesses.
The dental health project sampled children across Los Angeles County from the age groups of 2 5 years old, 6 8 years old, and 14 16 years old.
Samples were drawn from Women, Infants and Children (WIC) centers; Head Start programs; and schools. A total of 2,313 children were
examined across 59 sites. Overall findings demonstrated a high evidence of dental caries among the underprivileged that is, almost half (44%)
of surveyed underprivileged in the County had cavities, and an additional 29% showed signs of early dental caries.
More specifically, The Childrens Dental Health Project of Los Angeles County concluded that:
The highest dental caries prevalence rate occurred in White Hispanic elementary school students, followed by non White Hispanics,
Asians, and African Americans.
Almost one out of every four (21%) underprivileged children were uninsured and 60% were covered by a public program, such as Denti
Cal, Medicaid, or Healthy Families.
Nearly three fourths of the county wide sample was classified as needing dental care within 15 days; and 9% were in need of immediate
dental care within 24 hours.
Only 6% of those sampled used tap water as their main source of drinking water a significant free source of fluoride.
86% of parents were not following the recommended American Association of Pediatric Dentistry guidelines that children should visit the
dentist by his/her first birthday.
The study found that half of Los Angeles County dental offices and clinics were not serving children covered by Denti Cal and average wait times
for an appointment were 3.7 days for new patients and 3.5 days for existing patients. Furthermore, only 44% of dental facilities treated children
under the age of two.
To advance improvements of oral health for the underprivileged, project investigators suggest partnering with community based providers to
establish dental homes in tandem with medical homes, increase dentists participation in Denti Cal and Healthy Families, increase dental training
and oral assessments for younger children infants and toddlers, develop a community oral health workers/promotores program to promote

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

effective oral care and prevention, promote the importance of drinking fluoridated tap water and brushing with fluoridated toothpaste, and
integrate oral health programs into current nutrition programs.

5. Health Literacy
Healthy People 2010 defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic
health information and services needed to make appropriate health decisions. This capacity would include the ability to read and comprehend
prescription bottles, appointment slips, and the other essential health related materials required to successfully function as a patient (American
Medical Association). In other words, health literacy is the ability to read, understand, and act on health care information as simplified by the
Center for Health Care Strategies Inc. Health Literacy Fact Sheet.
Patients with low health literacy are characterized as less likely to understand physical written and oral information, or successfully obtain
needed services by navigating the health care system, or follow directions in taking medications and appointment schedules. Those lacking
appropriate levels of literacy are more likely to have higher health care costs as well. According to the National Adult Literacy Survey:
Two thirds of American adults age 60 and over have inadequate or marginal literacy skills.
Half of welfare recipients read below the 5th grade level.
Half of Hispanic/Latinos and 40% of African Americans have some degree of reading difficulty.19
Research studies indicate that poor health status is disproportionately higher among patients with low functional health literacy. Those with low
health literacy are more likely than those with higher levels of health literacy to have a chronic disease and not get the health care they need.
Furthermore, emergency room patients who lack appropriate health literacy skills are likely to need hospitalization twice as often, after
controlling for self reported health status, health insurance coverage and income level.20
The Office of Minority Health, which is a division within the U.S. Department of Health and Human Services, created the National Standards for
Culturally and Linguistically Appropriate Services with the purpose to improve communication between providers and patients from racially and
ethnically diverse backgrounds. Locally, California is considering legislation to direct medical schools to provide training in cultural competency
and/or health literacy skills. The National Board of Medical Examiners has implemented a clinical skills test as part of the U.S. Medical Licensing
Examination to asses a doctors level of communication skills. Results from the Health People 2010 report indicated that much effort is still
needed to increase provider patient communication. Health communication survey items asking patients 18 years and older if health providers

19
20

Center for Health Care Strategies, Inc., Health Literacy Fact Sheet
Center for Health Care Strategies, Inc., Health Literacy Fact Sheet

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

always listen carefully to them, explain things so they can understand, show respect for what they have to say, or spend enough time with them
were each down by double by digits based on the Healthy People performance targets.21

6. Fitness and Nutrition


6.1 Physical Activity
Longitudinal data from the Los Angeles Health Survey shows an increase in physical activity over a five year period for County residents. In 2007,
over half (53.2%) of Los Angeles County residents responded having an active lifestyle compared to forty eight percent (48.0%) in 2002. 46.9%
admitted to leading a minimally active to sedentary lifestyle in 2007, which is a decrease from 51.9% in 2002.
Data for SPA 6 in SVMCs primary service area also shows an increase in the percentage of active adults from 2002 (45.4%) to 2007 (51.5%) and
a decrease is the percentage of sedentary adults from 2002 (46.7%) to 2007 (38.9%) though both percentages are above the Los Angeles
County rates. Data for SPA 4, also in SVMCs primary service area, while better overall, shows smaller improvements, with a slight increase in
the percentage of active adults from 2002 (52.9%) to 2007 (53.7%) and a decrease is the percentage of sedentary adults from 2002 (38.1%) to
2007 (35.1%) though both percentages are above the Los Angeles County rates.

21

Healthy People 2010

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 59. Prevalence of Physical Activity for Adults (18+ years) by SPA, 2007
2007

2005

Percentage Estimated #
Los Angeles
County

Active (Meets Guidelines)

53.2%

Some Activity (Does Not Meet Guidelines)


Minimal to No Activity (Sedentary)

Metro (4)

West (5)

South (6)

51.8%

10.7%

793,000

36.2%

2,687,000

Some Activity (Does Not Meet Guidelines)

55.3%
10.2%

Minimal to No Activity (Sedentary)

South Bay (8)

Percentage

Estimated #

3,749,119

48.0%

10.6%

769,916

10.1%

689,879

37.5%

2,712,284

41.8%

2,903,900

869,000
160,000

50.1%
10.6%

769,181
163,416

48.2%
10.3%

698,383
148,188

34.6%

543,000

39.2%

601,973

41.5%

608,729

Active (Meets Guidelines)

50.4%

698,000

51.4%

676,441

44.6%

552,714

Some Activity (Does Not Meet Guidelines)

10.2%

141,000

11.6%

152,126

11.9%

147,593

Minimal to No Activity (Sedentary)

39.4%

545,000

37.1%

488,173

43.5%

556,121

3,225,601

Active (Meets Guidelines)

53.7%

500,000

53.6%

488,853

52.9%

432,141

Some Activity (Does Not Meet Guidelines)

11.2%

105,000

10.7%

97,769

9.1%

77,201

Minimal to No Activity (Sedentary)

35.1%

327,000

35.7%

325,642

38.1%

325,441

Active (Meets Guidelines)

57.3%

298,000

61.9%

330,114

56.3%

281,163

Some Activity (Does Not Meet Guidelines)

11.2%

58,000

11.3%

59,985

11.3%

55,846

Minimal to No Activity (Sedentary)

31.4%

163,000

26.8%

142,784

32.4%

168,837

Active (Meets Guidelines)

51.6%

349,000

45.6%

300,295

45.4%

272,744

Some Activity (Does Not Meet Guidelines)


East (7)

Percentage Estimated #

3,951,000

Service Planning Area


San Fernando (2) Active (Meets Guidelines)

San Gabriel (3)

2002 03

9.5%

64,000

9.8%

64,802

7.9%

49,645

Minimal to No Activity (Sedentary)

38.9%

263,000

44.5%

293,226

46.7%

290,305

Active (Meets Guidelines)

51.9%

495,000

51.5%

478,185

48.3%

415,264

Some Activity (Does Not Meet Guidelines)

12.1%

115,000

10.2%

94,788

8.1%

67,536

Minimal to No Activity (Sedentary)

36.0%

343,000

38.3%

356,078

43.7%

390,549

Active (Meets Guidelines)

53.7%

621,000

52.5%

590,063

45.7%

478,356

Some Activity (Does Not Meet Guidelines)

11.3%

131,000

10.0%

112,965

11.2%

122,565

Minimal to No Activity (Sedentary)

35.0%

405,000

37.5%

421,527

43.1%

471,352

Source: 2007, 2005 and 2002 03 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County Department of Public Health.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

6.2 Limited Activity (Number of Days)


Adults 18 years and older residing in Los Angeles County also report spending fewer days being inactive in the past 30 days due to poor physical
and/or mental health. Countywide, in 1999 adults spent 2.4 average days in the past 30 days of limited activity in 1999. In 2007 the average
number of days in the last 30 days of limited activity has declined to 2.1 average days.
SPAs 4 and 6 in SVMCs primary service area show consistently higher average number of days of limited activity in the last 30 days than the
remaining SPAs and the County overall. SPA 6 averaged 2.6 in 1999 200, 2.7 in 2002 03, spiked up to 3.3 in 2005 and dipped slightly to 3.1 in
2007. However, SPA 4 has demonstrated a positive trend, averaging 2.6 days in 2002 2003 and 2005 and decreasing to 2.2 days in 2007, only
slightly higher than the County average.
Figure 60. Average Days in the Past 30 Days of Limited Activity Due to Poor Physical and/or Mental Health for Adults (18+ years) by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Average
2.1

2005
Average
2.4

2002 03
Average
2.4

2.0
1.8
2.2
1.6
3.1
2.1
2.0

2.4
1.8
2.6
2.3
3.3
2.3
2.5

2.2
2.5
2.6
1.7
2.7
2.2
2.5

1999 00
Average
2.4
2.3
2.1
2.3
2.1
2.6
2.4
2.9

Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA
County Department of Public Health.

6.3 5 Servings of Fruits and Vegetables


The consumption of fruits and vegetables is vital to health. A diet low in nutritional value can lead to birth defects, mental and physical
retardation, weakened immune systems, blindness, and even death (LACDPH, 2007). The percentage of the population by zip code that
consumed at least 5 servings of fruits and vegetables in one day in 2005 is reported in Figure 61. Less than half of the population in the SVMC
primary service area consumed at least 5 servings of fruits and vegetables per day. Regardless of the economic diversity and various levels of

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

access to fresh fruits and vegetables, there is not much difference among the zip codes in this primary service area, with percentages ranging
from 39.5% (90008) to 46.2% (90017).
Figure 61. Percentage of those Consuming 5 Fruits and Vegetables per Day (Population 5 and Over) in SVMCs Primary Service Area, 2005
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057

Percentage
44.2%
44.5%
44.7%
43.5%
39.5%
43.0%
43.1%
41.0%
46.2%
41.1%
43.3%
42.8%
44.3%
44.2%
45.0%
44.4%
43.3%
42.0%
42.6%
45.8%
45.0%

Source: California Health Interview Survey, 2003 2005

There is however a larger fruit and vegetable consumption difference among Service Planning Areas, with a range from 12.7% in the South to
22.7% in the West in 2007. In SVMCs primary service area, SPA 4 (15.3%) has a slightly larger percentage of those eating 5 or more servings of
fruits and vegetables than Los Angeles County (15.1%) while SPA 6 has a smaller percentage (12.7%).

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 62. Percentage of Adults (18+ years) Reported Having Eaten 5 or More Servings of Fruits/Vegetables in the Past Day by SPA, 2007
2007
Los Angeles County
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

Percentage
15.1%

Estimated #
1,080,000

17.0%
13.5%
15.3%
22.7%
12.7%
13.8%
13.6%

258,000
178,000
136,000
111,000
83,000
128,000
152,000

2005
Percentage
14.6%
13.0%
15.3%
15.0%
19.4%
10.7%
13.9%
16.6%

2002 03
1999 00
Percentage Percentage
12.3%
11.6%
13.2%
12.2%
12.1%
17.8%
8.9%
11.4%
11.3%

13.1%
11.9%
11.0%
13.2%
9.9%
9.8%
11.9%

Source: 2007 and 2005 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County Department of Public Health.

6.4 Breakfasts (Daily Consumption)


Survey data at the County, SPA and Health District levels indicate increased physical activity and decreased limited activity; and the same
population reported a larger percentage are eating breakfast daily in a typical week across the same geographies. Across Los Angeles County in
2005, three out of every four (77.2%) parents of children aged 2 17 years old reported that their child ate breakfast every day. Two years later,
eight out ten (84.2%) parents of children aged 2 17 years old reported that their child ate breakfast every day.
Breakfast consumption levels have increased over a two year period across each SPA as well, with the largest jump occurring in SVMCs primary
service area. in SPA 6 with an increase of 11.2%, followed by SPA 2 (9.0%), SPA 4 (8.1%) and SPA 3 (7.8%).

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 63. Percentage of Parents of Children (2 17 Years) Who Reported Their Child Ate Breakfast Daily in a Typical Week by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

Percentage
84.2%
86.5%
84.1%
85.7%
80.8%
87.0%
81.6%
82.4%

2007
Estimated #
2,112,000
430,000
373,000
245,000
81,000
282,000
301,000
322,000

2005
Percentage
77.2%
77.5%
76.3%
77.6%
80.8%
75.8%
78.8%
75.8%

Source: 2007 and 2005 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA
County Department of Public Health.

6.5 Fast Food


Note: Data in this section has not been updated since the 2007 community needs assessment.
In 2005, one fourth (25.8%) of children (2 17 years old) in Los Angeles County were reported to have eaten fast food yesterday. Previously in
1999, two tenths (21.0%) of children in Los Angeles County were reported to have eaten fast food in the previous day. Across SPAs, there are
more children who reported to have consumed fast food in 2005 compared to 1999. The largest six year rise occurred in SPA 7 at 11.9%,
followed by 6.4% in SPA 6 and 5.7% in SPA 8. Fast food consumption levels in SVMCS primary service area (24.7% and 24.9%) are slightly below
the Los Angeles Countys rate of 25.8%.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 64. Percentage of Children (2 17 Years) Who Ate Fast Food Yesterday by SPA, 2005

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5) **
South (6)
East (7)
South Bay (8)

2005
Percentage Estimated #
25.8%
633,000
24.2%
26.6%
24.7%
17.4%
24.9%
28.7%
28.2%

117,000
116,000
65,000
17,000
79,000
109,000
106,000

2002 03
Percentage
17.5%

1999 00
Percentage
21.0%

17.1%
18.9%
18.1%
13.4%
16.6%
18.9%
16.4%

20.3%
25.4%
23.5%
18.7%
18.5%
16.8%
22.5%

Source: 2005, 2002 and 1999 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA
County Department of Public Health.

D. RISK BEHAVIORS
1. Obesity
Obesity is cited by focus group and interview participants as one of the major and most complex health concerns today. It also represents one of
the worst health trends in recent years, especially among children and among Latinos. One participant described it as a soaring trend, but not a
new one, that just keeps worsening. Some low income communities have a prevalence of fast food restaurants but are limited in access to
fresh fruits and vegetables. Access to fast food is not only easy in these communities, but it is also one of the few affordable choices for low
income families. As one participant stated, Obesity is hardly just a medical issue. There is no pill to take. Its also a city planning issue that has
to do with how we access food, what kind of food, open space, community violence, and so forth.
1.1 Overweight and Obesity
In 2007, 57.4% of the population age 12 and over in Los Angeles County were either overweight or obese. Both service planning areas in SVMCs
primary service area, SPA 4 and SPA 6, had an increase in overweight/obesity rates from 2003 2005 to 2007. SPA 6 (65.2%) had a higher rate of
overweight/obesity than the Los Angeles County. In SPA 6, over one third (34.4%) of its population were obese in 2007, up from 23.8% in 2003
2005.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 65. Percentage of Overweight and Obese (12+ years) in Los Angeles County by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

Overweight
(BMI >25 and <30)
2007
2003 2005
34.8%
35.0%

Obese
(BMI 30+)
2007
2003 2005
22.6%
20.8%

Total
(BMI 25+)
2007
2003 2005
57.4%
55.8%

34.4%
34.7%
36.7%
32.5%
30.8%
41.0%
33.1%

20.4%
20.7%
18.3%
12.7%
34.4%
26.6%
25.4%

54.8%
55.4%
55.0%
44.2%
65.2%
67.6%
58.5%

35.2%
33.9%
33.4%
32.5%
38.0%
37.3%
34.4%

19.0%
20.4%
17.6%
13.7%
23.8%
26.7%
22.9%

54.2%
54.3%
51.0%
45.2%
61.8%
64.0%
57.3%

Source: California Health Interview Survey (CHIS)

In 2003 2005, 12 out of the 21 zip codes in this primary service area had a majority of their population ages 12 and over who were overweight or
obese. The zip code with the highest rate of overweight/obesity during those years was 90008, at 59.8%. Please see Figure 66 for more detail.
Figure 66. Percentage of Overweight and Obese (12+ years) in SVMCs Primary Service Area, 2005
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019

Overweight
(BMI >25 and <30)
31.2%
31.4%
33.1%
31.4%
34.3%
29.1%
35.9%
34.7%
33.7%
34.7%
31.7%

Obese
(BMI 30+)
17.3%
17.3%
19.5%
18.8%
25.5%
13.6%
22.8%
23.6%
19.8%
23.7%
19.6%

Total
(BMI 25+)
48.5%
48.9%
52.6%
50.2%
59.8%
42.7%
58.7%
58.3%
53.5%
58.4%
50.3%

Zip Code
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057

Overweight
(BMI >25 and <30)
28.6%
31.9%
30.5%
31.8%
31.9%
30.7%
35.2%
33.8%
32.1%
32.2%

Obese
(BMI 30+)
14.6%
17.8%
15.9%
17.5%
18.2%
17.3%
23.6%
25.4%
15.9%
18.3%

Total
(BMI 25+)
43.2%
49.7%
46.4%
49.3%
50.1%
48.0%
58.8%
59.2%
48.0%
50.5%

Source: CHIS, 2003 2005

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

2. Smoking
Note: Please note that data in this section has not been updated since the 2007 community needs assessment.
Cigarette smoking is the leading cause of preventable death in the United States and is a risk factor for diseases such as cardiovascular disease,
respiratory disease, and lung cancer (LACDPH, 2010). Each year nearly 9,000 lives and $4.3 billion are lost to smoking related disease in Los
Angeles County. In 2005, approximately 15%, or nearly one out of every six adults 18 years and older smoked cigarettes in Los Angeles County.
This is down approximately 4% from the late 1990s.
Smoking decreased in Los Angeles County from 2002 (15.2%) to 2005 (14.6%) as well as in five of the six SPAs, except SPA 6, which is in
SVMCs primary service area, where smoking increased from 2002 (15.3%) to 2005 (17.3%).
In 2005, the percent of adult smokers in SVMCS primary service area is larger than the percent of adult smokers in Los Angeles County
(16.4% in SPA 4 and 17.3% in SPA 6 vs. 14.6%).
Figure 67. Percentage of Adults (18+ years) who Smoke Cigarettes by SPA, 2005

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2005
Percentage Estimated #
14.6%
1,067,000
14.5%
12.9%
16.4%
13.3%
17.3%
10.7%
16.7%

223,000
171,000
150,000
71,000
115,000
101,000
190,000

2002 03
Percentage
15.2%

1999 00
Percentage
18.1%

1997
Percentage
18.2%

14.6%
14.3%
16.8%
13.7%
15.3%
14.7%
16.4%

18.1%
15.4%
20.3%
19.2%
19.1%
17.1%
18.4%

18.8%
18.6%
18.8%
13.3%
18.9%
19.0%
17.4%

Source: 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of
Public Health.

2.1 Established Smokers


In 2007, across Los Angeles County, 14.3% of residents are current, established smokers and an additional 1.1% smoke occasionally. SPAs 4 and
6 in GSHs primary service area have the highest percentage of established smokers (15.7% and 19.7%). Please see Figure 68 for more data.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 68. Percentage of Adults (18+ years) Who Are Current, Non Regular, Former and Non Smokers by SPA, 2007

Los Angeles County

Service Planning Area


San Fernando (2)

San Gabriel (3)

Metro (4)

West (5)

South (6)

2007
Percentage
Estimated #
14.3%
1,061,000
1.1%
79,000
21.2%
1,572,000
63.5%
4,713,000

Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker
Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker
Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker
Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker

13.3%
0.9%
25.5%
60.2%

209,000
15,000
401,000
946,000

11.9%
1.0%
19.1%
68.1%

163,000
14,000
262,000
936,000

15.7%
1.2%
20.1%
63.0%

146,000
12,000
188,000
587,000

2005
Percentage
13.9%
0.8%
23.3%
62.1%

13.9%
0.5%
26.3%
59.3%
11.9%
1.0%
22.6%
64.5%
15.5%
0.9%
23.2%
60.4%

2002 03
Percentage
14.4%
0.9%
22.9%
61.8%

13.9%
0.7%
24.7%
60.7%
13.2%
1.1%
20.5%
65.2%
15.8%
1.0%
22.9%
60.2%

Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker

9.7%

51,000

13.1%

13.1%

26.7%
63.4%

140,000
332,000

27.0%
59.6%

24.4%
61.8%

Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker

19.7%
1.2%
16.9%
62.3%

133,000
8,000
114,000
422,000

16.1%
1.3%
20.0%
62.6%

13.9%
1.3%
19.6%
65.1%

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

East (7)

South Bay (8)

Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker
Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker

2007
Percentage
Estimated #
13.8%
131,000
1.6%
16,000
19.2%
183,000
65.4%
625,000
15.5%
0.9%
20.4%
63.3%

179,000
10,000
235,000
730,000

2005
Percentage
10.0%
20.8%
68.5%

15.9%
0.8%
22.1%
61.2%

2002 03
Percentage
13.3%
*
1.5%
20.4%
64.8%

16.0%
0.5%
25.2%
58.3%

Source: 2007, 2005, 2002 03 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County Department of Public Health.
* The estimate is statistically unstable (relative standard error > 23%) and therefore may not be appropriate to use for planning or policy purposes.
19. Estimates may differ from prior estimates as new weights were utilized beginning March 20, 2006.

2.2 Smoke Exposure


Note: Data in this section has not been updated since the 2007 community needs assessment.
Childhood exposure to secondhand smoke can increase the likely of getting sick, wheezing and coughing, asthma attacks, and ear infections.
Furthermore, secondhand smoke can limit the development of the lungs and lead to bronchitis and pneumonia. For infants, exposure to
cigarette smoke can lead to Sudden Infant Death Syndrome (Center for Disease and Control). In Los Angeles County, 6.4% of parents with
children admitted their child was exposed to tobacco smoke at home (2005). This estimate is down 1.1% from 2002 and down an additional
4.7% from 1999. A larger proportion of tobacco exposure occurred in children aged 6 17 years versus from 0 5 years of age (7.9% vs. 3.2%).
In SVMCs primary service area, SPA 4 (3.2%) had smaller percentage of children being exposed to tobacco in the home than Los Angeles County
(6.4%). However, SPA 6 (10.7%) had a larger percentage of children exposed to tobacco in the home.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 69. Percentage of Parents of Children (0 17 Years) Who Reported Their Child Exposed to Tobacco Smoke in the Home by SPA,
2005

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2005
Percentage Estimated #
6.4%
178,000

6.6%
4.9%
3.2%
3.7%
10.7%
5.3%
7.6%

36,000
24,000
10,000
4,000
38,000
22,000
34,000

2002 03
Percentage
7.5%

1999 00
Percentage
11.1%

5.4%
7.4%
7.6%
6.9%
9.3%
6.6%
8.2%

11.2%
9.3%
9.6%
13.9%
10.6%
11.2%
11.8%

Source: 2007, 2005, 2002 and 1999 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA
County Department of Public Health.

3. Alcohol Use
Although moderate alcohol consumption is common among adults with no adverse effects, alcohol abuse can cause medical consequences such
as cardiovascular disease, hypertension, cancer, and liver disease (LACDPH, 2001). Approximately 100,000 deaths each year can be attributed to
alcohol and an estimated $184.6 billion is spent on alcohol related problems each year in the U.S. (LAC/DHS 2001). In Los Angeles County in
2005, more than half of adults (53.6%) reported drinking alcohol in the past month, and approximately one in six (17.3%) admitted to binge
drinking (five or more drinks for men or three or more drinks for women) at least once in the past month. One out of every 25 adults, or 4.3%,
admitted to consuming 60 or more drinks in the past month. For 2007, alcohol use in SVMCs primary service area SPA 4 (49.7%) and SPA 6
(43.3) is lower than Los Angeles County (52.0%).

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Figure 70. Percentage of Adults (18+ years) Who Reported Drinking Alcohol in the Past Month by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Percentage Estimated #
52.0%
3,877,000
60.8%
47.2%
49.7%
64.7%
43.3%
45.1%
52.9%

960,000
651,000
465,000
336,000
295,000
432,000
613,000

2005
Percentage
53.6%
61.8%
49.4%
51.1%
68.9%
38.7%
47.7%
56.2%

2002 03
1999 00
Percentage Percentage
54.3%
54.4%
59.1%
50.8%
52.7%
70.6%
44.0%
49.7%
55.4%

58.2%
52.7%
53.1%
67.2%
44.2%
49.8%
56.1%

Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health

3.1 Binge Drinking


In general, binge drinking rates have dropped since the 2007 community needs assessment. In 2007, 16.2% of adults in Los Angeles County were
binge drinking, down from 17.3% in 2005. In SVMCs primary service area, SPA 4 (18.3%), and SPA 6 (17.9%) percentages are slightly higher
compared to Los Angeles County. Data in Figure 71 shows SPA 4 experienced a slight decrease in binge drinkers from, 19.2% in 2005 to 18.3% in
2007. However, In SPA 6, the percentage of binge drinkers increased from 13.7% in 2005 to 17.9% in 2007.
Figure 71. Percentage of Adults (18+ years) who Reported Binge Drinking* in the Past Month by SPA, 2007
2007
Los Angeles County
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

Percentage
16.2%

Estimated #
1,190,000

2005
Percentage
17.3%

16.2%
13.8%
18.3%
12.8%
17.9%
18.5%
15.9%

253,000
188,000
169,000
66,000
121,000
174,000
183,000

18.3%
16.1%
19.2%
17.4%
13.7%
17.8%
17.6%

Source: 2007, 2005 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health.
* Binge drinking for females is drinking 4 or more drinks and males 5 or more drinks on one occasion at least one time in the past month.

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3.2 Chronic Drinking


In 2007, 3.3% of adults in Los Angeles County reported chronic or heavy drinking; this is down from 4.3% in 2005. In SVMCs primary service
area, SPA 4 had lower percentages of chronic or heavy drinkers from 2005 to 2007. On the contrary, SPA 6 experienced an increase from 2005
to 2007. Figure 72 below details the percent of adults who reported chronic drinking in the past month in 2005 and 2007.
Figure 72. Percentage of Adults (18+ years) Who reported Chronic Drinking* in the Past Month by SPA, 2007
2007
Los Angeles County
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

Percentage
3.3

Estimated #
242,000

2005
Percentage
4.3

4.0
2.6
3.8
2.7
3.4
2.6
3.5

63,000
35,000
34,000
14,000
23,000
24,000
40,000

4.7
3.6
5.3
4.5
3.1
2.9
5.5

Source: 2007, 2005 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health
* Chronic/Heavy drinking is males consuming more than 60 drinks and females more than 30 drinks in the previous month.

4. Drug Use
In 2007, approximately 2% (153,000) of Los Angeles County adults were treated for substance abuse or addiction in the past five years.
Compared to Los Angeles County, SVMCs primary service area reported higher substance abuse rates (2.1% for SPA 4, and 3.0% for SPA 6). SPA
6 (3.0%) had one of the highest proportions of adults receiving drug abuse treatment across Los Angeles County.
Figure 73. Percentage of Adults (18+ years) Who Reported Receiving Treatment for Substance Abuse or Addiction by SPA, 2007
2007
Los Angeles County
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)

Percentage
2.0

Estimated #
153,000

2.2
1.5
2.1
1.7

34,000
20,000
20,000
9,000

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politan Hospital Co
ollaborative SB 697
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2007
South (6)
East (7)
South Bay (8)

Perce
entage
3
3.0
0
0.9
2
2.9

Estim
mated #
21,000
9
9,000
33,000

Source: 2007 Los Angeles County Health Survey; Office of Health Asssessment and Epidemiiology, LA
County Department off Public Health.

5. Youth Involveed in Gangs


When asked direcctly on the California Healthy Kidss Survey from 200
06 2008, Do
you consider you
urself a member of a gang? app
proximately 6% to 8% of girls
and 11% of boys in grades 7, 9, an
nd 11 reported that they consider themselves
gang members. Students enrolleed in Community Day Schools or continuation
programs, were more likely to report gang invo
olvement (11.9% of girls and
21.1% of boys). Also, studen
nts who reportted lower levels of school
connectedness; such as not being treated fairly, no
ot feeling close to
o people, not
happy, or not fee
eling safe at scho
ool; were nearly three times moree likely to be
involved in gangg membership th
han students wh
ho reported high
her levels of
school connected
dness. By racial/eethnic group, Afrrican American sttudents were
most likely (14.5%) to be gang in
nvolved and Asian students (6.9%
%) were least
likely to report being involved with gangs. Eleven
n percent of Natiive American
and Pacific Islaanders were in
nvolved with gangs and 10 percent of
Hispanic/Latinos.
Approximately 9.9% to 12.8% of Los Angeles County youth reported gang
membership in 2006 2008. San Bernardino Countty, which is the laargest county
in the state and lies adjacent to Los Angeles Coun
nty, showed a higgher range of
gang involvemen
nt (12.8% to 16.3
3%). Orange Co
ounty as well as Los Angeles
Countys other neighbors had similar gang mem
mbership particip
pation levels.
Los Angeles Countys range co
ompared to som
me of Californiaas Northern
Counties was high
hest at 16.3% to 24.1%.22

22

Figure 74. Re
eports of Gang Membership by County,
2006 200
08

%
%
t

Kidsdata.org

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6. Youth Arrest//Felonies
Juvenile felony arrest rates weree on the declinee from 1998 to
2004 among youth ages 10 to 17
7. However from
m 2005 through
2008 the rates haave slightly increeased across the state and most
populated countties. Statewide, the majority off felony arrest
cases involved boys, ages 13
3 17, and adoleescent African
Americans. In 20
008, youth were arrested on felo
ony charges for
property offense
es (39.3%); violen
nt offenses, such
h as homicide,
rape, robbery, assault, and kidnaapping (27.0%); other offenses
like weapons or hit and run (23.2
2%); drug and allcohol offenses
(8.6%); or sex offfenses (2%). Thee rate of juvenilee felony arrests
varies by county, from 7.7 per 1,000 youth ages 10 17 in
Humboldt Countyy to 34.7 in San Francisco in 2008
8. Keep in mind
that the rate of arrests can be influenced by multip
ple factors, and
are an imperfect measure of juven
nile criminal activvity.

08

1,000)

The rate of you


uth felony arrestts in Los Angelees County and
neighboring coun
nties was moderaate compared to the rest of the
state. Approximaately 11.6 to 15.5
5 per 1,000 of thee Countys youth were arrested on
n felony charges in 2008. San Berrnardino County, which is the
largest county in
n the state and lies adjacent to Los Angeles Cou
unty, was the sam
me. As well as for Los Angeles Countys other neighboring
counties except Kern County whicch had a higher yo
oung adult felonyy rate of 15.5 to 19.2 per 1,000. Orange County was lowest with a range of 7.7
to 11.6 per 1,000
0 youth felony ch
harges. Los Angeles Countys youtth felony arrest rate compared to
o some of Califorrnias Northern Counties was
highest at 19.2 to
o 34.7 per 1,000 youth.23 The Stattewide juvenile feelony arrest rate was 14.1 per 1,000.

23

Kidsdata.org

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

E.

CHRONIC DISEASE

Focus group and interview participants cited repeatedly chronic diseases as one of the top health issues facing their communities, including
diabetes, asthma, heart disease, and hypertension. The trend is not only apparent among adults, but it is also increasing for youth and children
in recent years. Many recent immigrants, including the undocumented, provide cheap labor in the informal, low wage, underground economy
that has become even more challenging during the recession. One participant referred to these immigrants as a permanent underclass.
Speaking specifically about Thai immigrants in this economy, one participant said that they experience a lot of stress and tension that has to do
with cultural displacement and dislocation, so they suffer from poor diet, high cholesterol, and high blood pressure or hypertension.

1. Diabetes
The prevalence of diabetes has been increasing across the globe and is now considered a worldwide pandemic. In Los Angeles County alone,
diabetes is the sixth leading cause of death since 1997 and an important cause of premature death since 1999 (LACDPH, 2010). Across SPA
(excluding SPA 6), Los Angeles County and California, the prevalence of diabetes has increased from 2003 to 2007. In 2007, 18.1% of adults ages
45 and over, almost 1 in 5, were diagnosed with diabetes, including borderline and pre diabetes. This is an increase from 14.6% in 2003 2005
and is also higher than the prevalence rate in California (15.9%). In SVMCs primary service area, SPA 4 significantly decreased from 2005
(20.8%) to 2007 (14.5%). SPA 6, however, increased from 2005 (22.2%) to 2007 (22.5%) and has the highest prevalence of diabetes among
adults age 45 and over.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 76. Comparison of Prevalence of Diabetes among Adults Age 45 and Over By SPA, 2007
25.0%

22.2%

20.8%
20.0%

18.1%

16.7%
16.1%
14.6%
14.4%
13.8%
13.1%

15.9%
15.0%

22.5%
20.8%
19.2%
17.2%

14.5%

14.2%

11.8%
8.9%

10.0%

2007
5.0%

2003 2005

0.0%

Source: California Health Interview Survey (CHIS), 2007

In 2003 2005, 17 of the 21 zip codes SVMCs primary service area had a higher prevalence of diabetes than Los Angeles County. The zip code
with the highest prevalence rate was 90037 (21.2%).
Figure 77. Percentage Diagnosed with Diabetes*(Adults Age 45 and Over) in SVMCs Primary Service Area, 2005
Zip Code
90004
90005
90006
90007
90008
90010
90011
Los Angeles County

Percentage
14.9%
15.7%
17.3%
19.8%
20.5%
16.2%
20.9%
14.6%

Zip Code
90016
90017
90018
90019
90020
90026
90027

Percentage
19.7%
18.0%
20.6%
16.2%
14.4%
15.6%
12.7%

Zip Code
90028
90029
90031
90037
90044
90046
90057

Percentage
14.2%
15.7%
16.9%
21.2%
20.9%
11.6%
17.0%

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

State

13.8%

Source: CHIS, 2003 2005


*Includes Borderline and Pre Diabetic

2. Asthma
In 2007, 11.8% of the population in Los Angeles County was diagnosed with asthma, which was comparable to the rate in 2003 2005. SVMCs
SPA 6 had an increase in percentage from 2003 2005 to 2007 (11.7% to 12.8%) but SPA 4 had a slight decrease (9.5% to 9.2%).
Figure 78. Percentage Diagnosed with Asthma by SPA, 2007

Los Angeles County

Percentage
2007
2003 2005
11.8%
12.0%

San Fernando (2)


San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

12.1%
11.4%
9.2%
13.9%
12.8%
9.8%
13.4%

11.5%
11.8%
9.5%
12.0%
11.7%
12.1%
13.7%

Source: California Health Interview Survey (CHIS)

In 2003 2005, 2 out of the 21 zip codes in this primary service area for SVMC had an asthma diagnosis rate higher than that of the County. Zip
code 90008 had the highest rate of asthma diagnosis during those years (13.0%).
Figure 79. Percentage Diagnosed with Asthma (All Ages) in SVMCs Primary Service Area, 2005
Zip Code
90004
90005
90006
90007
90008
90010
90011

Percentage
9.1%
8.7%
8.6%
10.0%
13.0%
9.5%
8.9%

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Zip Code
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Los Angeles County

Percentage
11.3%
8.2%
11.0%
10.5%
9.2%
9.2%
10.9%
10.6%
9.1%
8.9%
10.1%
12.2%
11.4%
8.7%
12.0%

Source: CHIS, 2003 2005

In 2007, 7.9% of the population under 18 years of age in Los Angeles County was diagnosed with asthma. This is a decrease by almost 1% from
2005 and a 0.2% decrease from 2002 03. SVMCs SPAs 4 and 6 both showed a decrease in diagnosis rates from 2005 to 2007 (6.7% to 4.1% for
SPA 4 and (9.0% to 7.8% for SPA 6). While SPA 6 is consistent with the rate for Los Angeles County, SPA 4 is lower.
Figure 80. Percentage of Parents of Children (0 17 Years) Who Reported Their Child Ever Diagnosed with Asthma and Currently Still Have
Asthma or Had an Asthma Attack in the past 12 months, 2007 by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)

2007
Percentage
Estimated #
7.9%
220,000
8.0%
7.6%
4.1%
7.6%
7.8%
8.8%

44,000
36,000
13,000
9,000
29,000
36,000

2005
Percentage
8.8%
7.9%
8.3%
6.7%
4.9%
9.0%
8.8%

2002 03
Percentage
8.1%
8.7%
8.4%
5.6%
13.0%
6.0%
7.7%

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

9.5%

South Bay (8)

42,000

11.0%

8.8%

Source: 2007, 2005, and 2002 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County
Department of Public Health.

2.1 Childhood Asthma Hospitalization Rate


In 2007, the following zip codes in SVMCs primary service area have an asthma hospitalization rate higher than 100 per 100,000 people under
20 years of age are (90008 (164), 90011 (123), 90016 (130), 90037 (205), 90044 (180), and 90057 (117).
Figure 81. Childhood Asthma Hospitalization Rate Per 1,000,000 People Under 20 in SVMCs Primary Service Area, 2007
Zip Code
90004
90005
90006
90007
90008
90010
90011

Rate
67
16
46
90
164
*
123

Zip Code
90016
90017
90018
90019
90020
90026
90027

Rate
130
65
66
74
25
68
36

Zip Code
90028
90029
90031
90037
90044
90046
90057

Rate
37
64
81
205
180
12
117

Source: Office of Statewide Health Planning and Development (OSHPD), 2007


* indicates data for this geographical area is not available or the sample size is too small.

3. Heart Disease
Overall, the prevalence of heart disease has increased every year in Los Angeles County from 1997 (4.8%) to 2007 (7.7%). Most SPAs in the
Metro Collaborative fall under Los Angeles Countys rate of eight percent (7.7%) of residents diagnosed with heart disease, except SPA 8 (9.0%).
Ten year percentage increases in heart disease by SPA averages around 2.7% compared to 2.9% across Los Angeles County. SVMCs SPAs 4 and
6 both show an increase in the percentage of adults diagnosed with heart disease from 2005 to 2007 (5.7% to 7.5% for SPA 4 and 6.4% to 7.6%
for SPA 6).
Figure 82. Percentage of Adults (18+ years) Diagnosed with Heart Disease by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)

2007
Percent Estimated #
7.7%
578,000
7.4%

117,000

2005 2002 03 1999 00


Percent Percent Percent
6.8%
6.2%
7.4%
6.8%

4.9%

6.9%

1997
Percent
4.8%
4.2%

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

San Gabriel (3)


Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Percent Estimated #
7.9%
109,000
7.5%
70,000
5.8%
30,000
7.6%
51,000
7.5%
72,000
9.0%
104,000

2005 2002 03 1999 00


Percent Percent Percent
7.4%
7.2%
8.1%
5.7%
5.3%
8.0%
7.4%
4.8%
5.9%
6.4%
7.0%
6.6%
7.2%
7.3%
6.9%
6.5%
6.3%
8.1%

1997
Percent
5.2%
4.2%
4.0%
4.9%
5.1%
5.8%

Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA
County Department of Public Health

4. Arthritis
Note: Data in this section has not been updated since the 2007 community needs assessment.
The percentage of adults diagnosed with arthritis is larger than the percentage of adults diagnosed with heart disease. However, the rise in the
percent of adults 18 years and older diagnosed with arthritis is less compared to the percentage of adults diagnosed with heart disease. Overall,
the prevalence of arthritis has increased every year in Los Angeles County from 1999 (16.4%) to 2005 (18.1%).
SVMCs SPA 4 (14.9%) fell below Los Angeles Countys rate (18.1%) of residents diagnosed with arthritis but SPA 6 ranked above (20.8%). Both
SPAs 4 and 6 showed an increase from the 2002 2003 rates (12.5% and 15.8%).
Figure 83. Percentage of Adults (18+ years) Diagnosed with Arthritis by SPA, 2005

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)

2005
2002 03
Percent Estimated # Percent
18.1%
1,313,000
15.7%
17.5%
17.6%
14.9%
15.3%
20.8%
18.0%

270,000
231,000
137,000
81,000
137,000
169,000

15.6%
17.7%
12.5%
10.6%
15.8%
14.2%

1999 00
Percent
16.4%
15.5%
18.9%
15.0%
13.1%
15.7%
17.5%

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

South Bay (8)

20.5%

233,000

17.8%

15.8%

Source: 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health.

5. High Blood Cholesterol


The largest reported chronic condition in Los Angeles County is high blood cholesterol. In 2007, 29% of adult residents in Los Angeles County
suffer from this condition. In 1999 00, the reported percentage was much lower at 16.1%. For 2007, SVMCs SPAs 4 and 6 reported lower
percentages (26.0% and 25.5%) than Los Angeles County but have increased significantly from 1999 00 (15.3% and 11.0%).
Figure 84. Percentage of Adults (18+ years) Diagnosed with High Blood Cholesterol by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Percentage
Estimated #
29.1%
2,154,000
29.1%
31.5%
26.0%
30.6%
25.5%
30.5%
29.6%

456,000
431,000
242,000
160,000
174,000
291,000
340,000

2005
Percentage
23.7%

1999 00
Percentage
16.1%

26.4%
23.0%
21.5%
21.8%
18.3%
27.1%
24.3%

18.0%
18.3%
15.3%
13.5%
11.0%
14.4%
17.2%

Source: 2007, 2005 and 1999 00 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County
Department of Public Health

6. Hypertension/High Blood Pressure


The Los Angeles County Department of Public Health reports that one out of four (24.7%) Los Angeles County adults were diagnosed with
hypertension in 2007 compared to only 15.8% of adults in 1997. Similar increasing trends are evident across SPAs, including GSHS primary
service area (SPA 4 and SPA 6). The prevalence of hypertension in the SPAs 4 and 6had double digit growth from 1997 to 2007 (13.8% vs. 24.8%
for SPA 4 and 15.3% to 26.0% for SPA 6).

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 85. Percentage of Adults (18+ years) Diagnosed with Hypertension by SPA, 2007

Los Angeles County


Service Planning
Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
2005
Percentage Estimated # Percentage Estimated #
24.7%
1,837,000
23.4%
1,699,940

23.7%
24.2%
24.8%
19.3%
29.0%
25.3%
25.0%

373,000
335,000
232,000
101,000
197,000
242,000
289,000

21.4%
24.5%
22.1%
16.8%
29.0%
23.9%
24.5%

330,164
324,552
202,274
88,831
192,491
223,297
278,219

2002 03
Percentage
20.1%

1999 00
Percentage
19.1%

1997
Percentage
15.8%

18.6%
19.7%
18.1%
16.5%
25.1%
19.9%
22.6%

18.9%
19.8%
19.0%
15.0%
20.1%
17.9%
20.4%

14.5%
17.6%
13.8%
13.2%
22.1%
16.0%
15.5%

Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health

F.

CANCER

1. Cases of Invasive Cancer


In 2010, 134,955 Californians will be diagnosed with
cancer and 54,655 will lose their life due to the disease.
Cancer is the second leading cause of death, accounting for
nearly one out of every four deaths (24%) in 2007. In 2002
2006, the overall cancer incidence rate in California was
lower compared to the nation. California cancer incidence
rates for Asian/Pacific Islanders, African Americans, and
non Hispanic whites were between three and five percent
lower than the nation. Hispanics in California had nearly
9% lower incidence rate than other Hispanics across the
country. It is worth noting that that state and national
differences in rates may be due to the difference in
categorizing the race/ethnicity of cancer cases between
California and Surveillance, Epidemiology, and End Results

California Cancer Statistics


Cancer incidence rates in California declined by 11% from 1988 to 2007.
Cancer incidence in California is about the same or somewhat lower than
elsewhere in the U.S. for most types of cancer.
Despite these improvements, nearly one out of every two Californians born today
will develop cancer at some point in their lives, and it is likely that one in
five will die of the disease.
Over the same period, cancer mortality rates declined by 21%. Mortality rates
declined for all four major racial/ethnic groups in the state.
The female breast cancer incidence rate in California has decreased by 7%, but the
mortality rate has decreased by 31%.
In 2006, the percent of women ages 18 and older in California who reported having
a pap smear in the previous three years was 88% for African Americans, 88% for
non Hispanic white women, 84% for Hispanics, and 84%for Asians.
Colon and rectum cancer incidence and mortality rates are declining sharply in
most racial/ethnic groups.
Source: California Cancer Registry, California Department of Public Health.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

(SEER) Program (American Cancer Society, CA Division, 2009).


In Los Angeles County, over 34,335 residents will be diagnosed with cancer in 2010. Seventeen percent will be attributed to breast cancer,
eleven percent due to colon cancer and five percent due to cervical cancer. 13,560 County residents will die due to cancer; specifically, 1,325
from colon cancer, 1,125 from cervical cancer and 375 from breast cancer.
Since 2007, cancer incidence rates have remained steady and the rate of screenings continues to improve.

2. Colorectal Cancer Screening (Blood Stool Tests)


Note: Data in this section has not been updated since the 2007 community needs assessment.
Colorectal cancer is an easily diagnosed condition with a good prognosis when caught at an early stage (PAS III 2005). However, according to
Asian American Network for Cancer Awareness (2003), more people die from colon cancer each year than breast cancer, prostate cancer, and
AIDS. Adults over the age of 50 should screen for colon cancer on a regular basis through colonoscopy every ten years or a sigmoidoscopy with a
blood stool test every three to five years (Asian American Network for Cancer Awareness 2003).
In Los Angeles County, screening rates for a sigmoidoscopy are on the rise. In 2005, 38% of adults in Los Angeles County reported having a blood
stool test within the past two years compared to 32.8% from 2002 2003. Blood stool test rates by SPA are in similar range to the County rate of
38.1%; rates by SPA range from a low of 35.6% in SPA 4 to a high of 43.3% in SPA 6, both the lowest and highest blood stool test rates are from
SVMCs primary service area.
Figure 86. Percentage of Adults (50+ years) Reported Having a Blood Stool Test Within the Past Two Years by SPA, 2005

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)

2005
Percentage
38.1%
38.7%
36.2%
35.6%
40.4%
43.3%
36.4%

Estimated #
910,000

2002 0319
Percentage
32.8%

203,000
175,000
93,000
75,000
75,000
106,000

34.0%
30.8%
32.9%
32.8%
33.6%
30.6%

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

South Bay (8)

40.2%

159,000

35.6%

Source: 2005 and 2002 03 Los Angeles County Health Survey; Office of Health Assessment and
Epidemiology, Los Angeles County Department of Health Services.

3. Cervical Cancer Screenings (Pap Smear)


There was a slight decrease of 1.4% in cervical cancer screenings among women from 2003 to 2005. However, by 2007 the percentage of women
receiving screenings increased by over half a percent (0.6%) to 84.4% across Los Angeles County. An overwhelming majority of Los Angeles
County women 18 years and older did report receiving a pap smear during the previous three years; however, the 2007 percentage (84.4%) was
not as high as in 2002 03 where 85.4% of women received a pap smear screening during the previous three years.
The majority of Service Planning Areas reported pap smear screening rates comparable to Los Angeles County over the same time period from
2007 through 1997. In 2007, GSHs SPA 4 (84.6%) and SPA 6 (88.3%) reported higher rates of pap smear screenings among women than Los
Angeles County (84.4%). GSHs SPA 4 and 6 experienced the greatest increase in pap smear rates since 1997 (17.8% and 17.3% respectively)
compared to other SPAs and Los Angeles County (11.6%). Difference comparisons in rates of increase from 2005 to 2007, however, were much
smaller. SPA 6 led with a 5.0%, year over year increase followed by under 2% for the remaining SPAs, except in San Fernando and San Gabriel
that both dipped in pap smear screenings from 2005 2007.
According to the American Cancer Society, cervical cancer is a major problem among many recent Californian immigrants. The incidence of
cancer, generally, is much lower for Hispanic and Asian/Pacific Islander subgroups than for non Hispanic whites and African American subgroups.
However, this is not the case for cervical cancer. Hispanic women have the highest risk of developing cervical cancer, twice as much compared to
non Hispanic white women, African American, and Asian/Pacific Islander women (American Cancer Society, 2009).
Figure 87. Percentage of Adult Women (18+ years) Reported Having a Pap Smear
(Within the Past Three Years for 2007, 2005 & 2002 03; Within the Past Two Years for 1999 00) by SPA, 1007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)

2007
Percentage Estimated #
84.4%
2,697,000
83.7%
81.3%
84.6%
87.3%

562,000
488,000
328,000
202,000

2005
Percentage
83.8%

2002 03
Percentage
85.4%

1999 00
Percentage
76.8%

1997
Percentage
72.8%

84.2%
84.1%
82.8%
85.6%

85.6%
83.2%
81.1%
88.2%

77.0%
72.4%
73.8%
81.7%

74.2%
73.3%
66.8%
76.4%

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

2007
Percentage Estimated #
88.3%
269,000
85.0%
342,000
84.8%
423,000

South (6)
East (7)
South Bay (8)

2005
Percentage
83.3%
84.9%
83.2%

2002 03
Percentage
89.9%
85.2%
87.4%

1999 00
Percentage
78.1%
75.7%
81.6%

1997
Percentage
71.0%
70.3%
76.5%

Source: 2007, 2005, 2002 03, 1999 00, 1997 Los Angeles County Health Surveys; Office of Health Assessment and Epidemiology, Los Angeles County
Department of Public Health

4. Breast Cancer Screenings (Mammogram)


Breast cancer is the second leading cause of death among women; however, rates of breast cancer have decreased over the years (American
Cancer Society, 2007). Breast cancer is the most common cancer among women in California, regardless of race (2009). More than three
fourths (77.9%) of the Countys women, age 50 and older, reported having a mammogram during the previous two years. Nearly three fourths
(73.7%) of the Countys women, age 40 and older, reported having a mammogram during the previous two years. For women 50 and older, this
rate is 2.7% percentage points higher in 2007 compared to 2005. More importantly, the highest reported mammogram rate was 79.0% in 1999
2000. For women 40 and older, this is 0.2% percentage points higher in 2007 compared to 2005. The current rate of 73.7% is the highest for this
age group, which was also seen in 1999 2000.
Across SPAs, the range in percentage of women receiving a mammogram is 68.5% to 78.5% for the 40 and older group and for women 50 and
older it is higher at 73.6% to 81.1%. In SVMCs primary service area, both SPAs 4 and 6 had slightly lower percentages of women 40 and older
who had mammograms in the past 2 years (68.5% and 72.0%). The rates for women 50 and older were 73.6% for SPA 4 and 81.1% for SPA 6.
Figure 88. Percentage of Women (40+ years) Reported Having a Mammogram in the Past Two Years by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Percentage
Estimated #
73.7%
1,591,000
75.4%
72.4%
68.5%
78.5%
72.0%
77.0%
73.3%

359,000
303,000
164,000
127,000
125,000
205,000
258,000

2005
Percentage
70.6%

2002 03
Percentage
73.5%

1999 00
Percentage
73.7%

1997
Percentage
70.7%

69.7%
72.4%
64.9%
71.7%
69.1%
74.6%
71.0%

73.4%
74.5%
70.1%
73.7%
71.6%
73.2%
75.4%

73.9%
72.5%
70.8%
76.1%
73.0%
73.6%
77.2%

68.3%
76.0%
67.6%
74.7%
70.3%
65.3%
72.7%

Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 89. Percentage of Women (50+ years) Reported Having a Mammogram in the Past Two Years by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Percentage
Estimated #
77.9%
1,087,000
77.9%
76.4%
73.6%
77.5%
81.1%
79.6%
79.7%

238,000
211,000
114,000
84,000
87,000
138,000
180,000

2005
Percentage
75.2%

2002 03
Percentage
77.9%

1999 00
Percentage
79.0%

1997
Percentage
76.2%

73.8%
77.5%
67.4%
76.9%
79.8%
80.3%
73.4%

78.6%
78.6%
70.7%
78.5%
78.2%
78.7%
80.0%

81.0%
79.0%
73.6%
84.1%
81.9%
76.5%
81.1%

73.9%
82.1%
72.6%
77.5%
78.9%
70.8%
76.8%

Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, Los Angeles County Department of Health Services

G.

HIV/AIDS

1. HIV/AIDS
As of December 2009, the HIV/AIDS Semi annual Surveillance Summary reported a total 56,091 diagnosed AIDS cases; 26,643 living cases and
31,448 reported deaths in Los Angeles County. Since 2005 the number of diagnosed AIDS cases has steadily dropped, from 2008 to 2009 the
number of diagnosed cases dropped by half (1,148 to 574). AIDS related deaths have also dropped since 2005, with the most notable drops
occurring from 2006 to 2007 (542 to 316, difference of 226) and 2008 to 2009 (282 to 127, difference of 155). With the number of related
deaths declining, the number of cases of individuals living with AIDS has slightly increased from 21,635 in 2005 to 24,643 in 2009.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 90. Cases of AIDS by Year of Diagnosis and Deaths among AIDS Cases, Los Angeles County, 2009
Diagnosed
Cases

Year
2005

1,449

Deaths

Living
Cases

570

21,635

2006

1,370

542

22,463

2007

1,183

316

23,330

2008

1,148

282

24,196

2009

574
56,091

127
31,448

24,643

Cumulative*

Source: Los Angeles County Public Health HIV/AIDS Semi Annual Surveillance Summary 2010
* The total count of cases since 1982.

By SPA, the number of AIDS cases reported annually has steadily declined since 2005. From 2005 to 2009, the number of reported AIDS cases
dropped from 464 to 178 for SPA 4 and from 191 to 72 for SPA 6. Please see Figure 92 for the number of AIDS cases by year for each SPA.
Figure 91. Annual Cases of AIDS by SPA, 2009
Los Angeles County
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2009
574

2008
1,148

2007
1,183

2006
11,370

2005
1,449

62
53
178
25
72
45
125

152
87
388
42
149
77
231

154
73
379
32
143
66
288

176
98
445
67
168
82
316

189
94
464
65
191
90
332

Source: Los Angeles County Public Health HIV/AIDS Semi Annual Surveillance Summary 2010

In 2009, gender by ethnicity numbers for persons living with AIDS in SVMCs primary service area SPAs 4 and 6, reveal that the majority of
reported cases were Hispanic males (4,214), White males (3,737), and Black males (2,386). The largest occurrence of male and female persons
living with AIDS is in SPA 4 (9,251). Please see Figure 92 for more details.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 92. Number of persons living with AIDS in SVMCs Primary Service Area by Gender and Ethnicity by SPA, 2009
San Fernando (2)
Male
Female
Gender
White
Black
Hispanic

San Gabriel (3)


Male
Female

Metro (4)
Male
Female

Male

West (5)
Female

South (6)
Male
Female

East (7)
Male Female

1,383

117

346

51

3,654

96

744

48

83

20

211

23

295

68

203

86

1,392

180

170

35

994

305

83

25

1,145

141

784

128

3,318

306

270

27

896

196

1,038

183

Source: Los Angeles County Public Health HIV/AIDS Semi Annual Surveillance Summary 2010
Data were not available for South Bay (8)

From 2005 to 2007, the number of deaths among AIDS cases declined within SVMCs primary service area. However, in 2007, the largest
number of AIDS related deaths in Los Angeles County occurred in SPA 4 (111), followed by 47 deaths in SPA 6.
Figure 93. Number of Deaths Among AIDS cases by SPA, 2007
2007
2006
2005
Los Angeles County
316
542
570
Service Planning Area
San Fernando (2)
35
69
81
San Gabriel (3)
21
45
42
111
195
201
Metro (4)
10
24
31
West (5)
47
69
63
South (6)
24
28
32
East (7)
62
101
114
South Bay (8)
Source: Los Angeles County Public Health HIV/AIDS Semi Annual Surveillance Summary 2010

1.1 HIV/AIDS, for Adolescents


In 2007, California had the third highest number of reported number of AIDS cases (41 out of 54 cases). At the end of 2007, 3,230 adolescents
ages 13 to 19 years were living with AIDS in the United States. The highest number of living cases occurred in New York with 768 cases, followed
by Florida at 540 cases and California at 172 living cases.24

24

CDC, HIV/AIDS Surveillance in Adolescents and Young Adults (through 2007)

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

In Los Angeles County, from 1982 through 2009 there were 292 diagnosed adolescent AIDS cases. The highest reported number of adolescent
AIDS cases in KFH LAs service area was in the Metro Service Planning Area with 74 cases among 13 to 19 year olds. In 2007, 60 adolescents were
living with AIDS in Los Angeles County. This is low compared to 2002 2004, where the numbers were in the high sixties. The most affected
racial/ethnic subgroup were Hispanic/Latinos with 30 reported adolescent cases, followed by African Americans with 16 reported adolescent
cases, and Whites with 5 cases. The total number of adolescent AIDs related deaths was 49 from 1982 to 2009, at a rate of less than 5 deaths
annually.25

H.

COMMUNICABLE DISEASES

1. Tuberculosis
The national tuberculosis (TB) rate in the United States has declined every year since 1993. From 2000 to 2008, the rate of TB cases decreased
by an annual average of 3.8%. Disproportionally higher cases of TB still remain for foreign born residents and minorities, especially for African
Americans (2009). From 2003 to 2007, the rate of TB cases in Los Angeles County also decreased, with 2007 being the fifteenth year of decline
since 1992. Also in 2007, the number of TB cases decreased by 8.2% from 2006. Despite the overall decreasing trend, Los Angeles County
accounted for the highest number of TB cases in 2007: 2,725 cases or 29.9% (LADPH, 2008).
Figure 94. TB Cases and Rates (Cases per 100,000 population) for Los Angeles County, 2007
% of Rate of
Change

Year

Cases

Population

Rate

2003

949

9,398,128

10.1

2004

930

9,535,937

9.8

3.4%

2005

906

9,582,956

9.5

3.1%

2006

885

9,644,738

9.2

2.9%

2007

816

9,689,462

8.4

8.2%

Source: LA County Department of Public Health, 2003 2007

According to 2007 Los Angeles County Department of Public Health data, TB affected (see Figure 95):
Males 1.5 times more than females (61.4% vs. 38.6%).
Individuals age 15 34 years (23.2%) and age 65 years and older (23.5%)
More foreign born individuals (79.3%)
25

2010 Los Angeles County Public Healths HIV/AIDS Semi Annual Surveillance Summary

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

A larger number of Hispanics/Latinos (358 cases or 43.9%) and Asian Americans (329 cases or 40.4%). But the infection rate was the
highest in Asian Americans (27.7 per 100,000), followed by African Americans (10.3 per 100,000)
Of those reported with TB in Los Angeles County during 2007, 7.9% were co infected with HIV. Of those with HIV and TB, the majority
were male (89.1%); Hispanic/Latino (64.1%); and in the 25 44 year age group (56.1%).
Figure 95. TB Cases and Rates (Cases per 100,000 population) by Gender, Ethnicity and Age for Los Angeles County, 2007
2003

2004

2005

2006

2007

Cases

Rate

Cases

Rate

Cases

Rate

Cases

Rate

Cases

Rate

Gender
Female

383

8.0

360

7.5

365

7.5

340

7.0

315

6.4

Male

566

12.2

570

12.1

541

11.4

545

11.4

501

10.4

Asian

346

27.7

337

26.6

323

25.8

329

25.9

329

25.6

African American

90

10.3

100

11.3

97

11.2

86

10.2

74

8.7

Hispanic/Latino

434

9.9

426

9.5

426

9.4

394

8.5

358

7.7

White
Native American/Alaskan
Native

78

2.7

67

2.3

58

2.0

75

2.6

54

1.9

3.5

0.0

3.5

3.5

0.0

00 04

21

3.1

24

3.4

24

3.3

28

3.9

25

3.4

05 14

17

1.1

20

1.3

12

0.8

13

0.9

0.6

15 34

246

8.8

216

7.8

206

7.4

219

7.8

189

6.7

Race/Ethnicity

Age Group

35 44

158

11.1

151

10.0

187

12.4

134

8.9

117

7.8

45 54

150

12.7

164

13.1

165

12.9

157

12.1

150

11.4

55 64

119

15.9

130

15.9

111

13.2

131

15.1

134

15.1

65+

238

22.9

225

23.2

201

20.7

203

20.7

192

19.0

Source: LA County Department of Public Health, 2003 2007

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

2. Hepatitis A
Viral hepatitis is caused by at least five different types of viruses. In the United States, acute viral hepatitis infections are most often caused
through the Hepatitis A virus (HAV), Hepatitis B virus (HBV), or Hepatitis C virus (HCV). These unrelated viruses are transmitted through different
routes and have varied adverse effects on the body. Vaccines are available for the first two types of hepatitis viruses. HBV has been available
since 1981 and HAV has been available since 1995 (Center for Disease Control, 2007). The Hepatitis A virus is preventable through the use of
vaccines. In fact, HAV rates are declining most for children in those states that had implemented the vaccine starting in 1999 (CDC, 2007). This
virus is transmitted from fecal matter to mouth, person to person and through food.
According to the 2008 LACDPH Annual Morbidity Report, the 2008 incidence rate in Los Angeles County was the same as the prior year 0.82
per 100,000 population vs. 0.80 per 100,000 population. This rate is lower than the statewide rate of 1.22 and the national rate of 0.86.
Hepatitis A occurred most often for those between the ages of 15 34 (1.2 per 100,000) and Asians (1.1 per 100,000). Reported cases for both
SPAs in SVMCs primary service area were low, SPA 4 7 cases (.5%) and SPA 6 2 cases (.2%).
Figure 96. Reported Hepatitis A, Acute Cases and Rates per 100,000 by SPA, 2008
Cases

Percentage

Rate/
100,000

San Fernando (2)

17

21.3%

0.8

San Gabriel (3)

17

21.3%

1.0

Metro (4)

8.8%

0.5

West (5)

10

12.5%

1.5

Service Planning Area

South (6)

2.5%

0.2

East (7)

15

18.8%

1.1

South Bay (8)

8.8%

0.6

Source: Los Angeles County Department, 2008 Morbidity Report


Rates calculated based on less than 19 cases or events are considered unreliable

3.

Hepatitis B

In the United States, Hepatitis B is a chronic infection that is the leading cause of chronic liver disease and cancer of the liver. Acute Hepatitis B
is more prevalent and infectious than AIDS (LADHS, 2008)26. It is transmitted through blood and bodily fluids of infected individuals and from
mother to child after birth. Chronic infections are more common among infants and children than adults.

26

LA County Department of Public Health, Annual Morbidity Report 2008

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

The Center for Disease and Control reports that the frequency of HBV cases was down 82% (8.2 cases per 100,000) in 1990. In 2007 the number
of cases was down 15% (1.5 cases per 100,000). However, in Los Angeles County, the incidence rate for acute Hepatitis B increased from 0.57
cases per 100,000 in 2007 to 0.68 cases per 100,000 in 2008 (LADHS, 2008)27.
In Los Angeles County, Hepatitis B affected most those between the ages of 55 64 (1.5 per 100,000); four times as much in males; and African
Americans (1.8 per 100,000). In SVMCs primary service area, SPA 6 had the highest rate of infection (2.1 per 100,000). Of the 22 cases in SPA 6,
eight were caused by an outbreak at a Long Term Care Facility (LADHS, 2008). SPA 4 had an infection of rate of 0.5 per 100,000, and seven cases
of acute Hepatitis B.
Figure 97. Reported Hepatitis B, Acute Cases and Rates per 100,000 by SPA, 2008
Cases

Percentage

Rate/
100,000

San Fernando (2)

13.6%

0.4

San Gabriel (3)

9.1%

0.3

Metro (4)

10.6%

0.5

West (5)

13.6%

1.4

South (6)

22

33.3%

2.1

East (7)

9.1%

0.4

South Bay (8)

6.1%

0.4

Service Planning Area

Source: Los Angeles County Department, 2008 Morbidity Report


Rates calculated based on less than 19 cases or events are considered unreliable

4. Hepatitis C
Hepatitis C is the most common blood borne infection in the United States (LADHC, 2008)28. However, surveillance of HCV remained difficult
because there is no one laboratory test that identifies cases (LADHC, 2008). An estimated 3.2M Americans are chronically infected with HCV. It
affects 600,000 California residents, causing 1,000 1,200 deaths in the state per year and is expected to triple in the next 20 years (Center for
Health Improvement, 2005)29. It is more common in Californias prison population with an estimated 41% of inmates infected with Hepatitis C.

27

LA County Department of Public Health, Annual Morbidity Report 2008


LA County Department of Public Health, Annual Morbidity Report 2008
29
Policy Brief: Stemming the Hepatitis C Epidemic in California Correctional Setting
28

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

From 2001 to 2003, the crude case rate of newly reported cases and the average number of cases were higher for LA County compared to
California (CA Department of Health Services, 2005)30.
In 2008, there were five cases of confirmed acute Hepatitis C in Los Angeles County, an increase from two cases confirmed in 2007. In SVMCs
primary service area, there were no cases of acute Hepatitis C reported in 2008.
Figure 98. Reported Hepatitis C, Acute Cases and Rates per 100,000 by SPA, 2008
Cases

Percentage

Rate/
100,000

San Fernando (2)

60.0%

0.1

San Gabriel (3)

20.0%

0.1

Metro (4)

0.0%

0.0

West (5)

0.0%

0.0

South (6)

0.0%

0.0

East (7)

0.0%

0.0

South Bay (8)

20.0%

0.1

Service Planning Area

Source: Los Angeles County Department, 2008 Morbidity Report


Rates calculated based on less than 19 cases or events are considered unreliable

5. Pertussis
During 2010, the Center for Disease Control reported several states are experiencing an increase in cases and/or localized outbreaks of pertussis,
including a state wide epidemic in California.31 In fact, as of August 2010, the Los Angeles County Health Department issued a pertussis health
alert. Los Angeles Countys occurrence of pertussis related deaths is currently at its highest in 15 years. In June 2010, the state of California
issued an epidemic of pertussis. The current year to date total number of confirmed or probable cases in Los Angeles County surpassed totals
for 2009. Pertussis is most serious in infants less than three months of age.32 Pertussis, or whooping cough, a highly contagious respiratory
disease that is caused by a bacterial infection, is preventable through vaccine. However, even the vaccinated can sometimes still become
infected because protection lasts only 5 to 10 years. Recently a pertussis vaccine has become available for preteens, teens, and adults.33

30

County health status profile 2005


Center for Disease Control and Prevention, Vaccines and Immunizations, Pertussis
32
County of Los Angeles Department of Public Health, August 2010 Pertussis Alert
33
County of Los Angeles Department of Public Health, Whooping Cough Fact Sheet
31

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Over the last 5 years, 8,000 25,000 cases of pertussis were reported per year in the United States.34 The June 2010 California Pertussis Summary
Report, concluded to date there have been 1,337 cases of pertussis; resulting in a state rate of 3.4 per 100,000. This equates to five times the
amount reported over the same period in 2009 (258 cases). Furthermore, if these current trends continue, California will report more cases of
pertussis than in the last 50 years. Los Angeles County pertussis rates range from 0 to more than 70 cases per 100,000. Rates are highest among
infants less than 6 months of age (69.6 per 100,000), children 7 9 years (10.2 per 100,000) and adolescents aged 10 18 years (9.3 per 100,000).
Rates by race/ethnicity are highest among Whites (3.3 per 100,000). Rates by age and race reveal that Hispanic infants less than 6 months of
age are most affected (94.2 per 100,000) and Whites aged 7 9 years (15.8 per 100,000).35
Figure 99. Pertussis Rate per 100,000 Population of Reported Cases*, by Race/Ethnicity and Age in California, January 1 June 30, 2010

White
Hispanic
API
Black

<6 mos
Rate
36.6
94.2
19.1
43.1

6 mos 6 yrs
Rate
6.1
3.4
0.5
2.6

7 9 yrs
Rate
15.8
4.3
1.9
2.5

10 18 yrs
Rate
14.4
3.4
2.8
1.3

19 64 yrs
Rate
1.0
0.6
0.2
0.3

65+ yrs
Rate
0.7
0.6
0.3
0.0

Source: Center for Disease Control and Prevention, Vaccines and Immunizations, Pertussis
*Out of 982 cases with known information

From 2006 to 2007 the Los Angeles County (LAC) Immunization Programs Fall Assessment found that the fourth dose of DTaP coverage in LAC
fell below the Healthy People 2010 target for kindergarteners and continues to be the most frequently missed childhood vaccine in Los Angeles
County and in the United States.36 The 2004 2008 five year average of confirmed and probable pertussis cases was 77.0. Specifically, in 2009
there were 53 reported cases of pertussis (0.51 per 100,000)37 and during the second quarter of 2009, the majority of pertussis cases occurred in
children less than one year of age (52.5%, n=31) followed by the 15 34 age group (15.3%, n=9) and 45 54 age group (8.5%, n=5).
In SVMCs primary service area, there were a larger number of cases reported than in Los Angeles County. SPA 6 reported the highest
number of cases (14) and SPA 4 reported 10 cases.38

34

Center for Disease Control and Prevention, Vaccines and Immunizations, Pertussis
LA County Department of Public Health Immunization Program, California Pertussis Summary Report (6/30/2010)
36
County of Los Angeles Department of Public Health, 2007 Annual School Immunization Assessment, Preschool and Kindergarten
37
LA County Department of Public Health Immunization Program, California Pertussis Summary Report (6/30/2010)
38
County of Los Angeles Department of Public Health, Vaccine Preventable Disease Surveillance Report, Quarter 2, 2009
35

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6. Sexually Transmitted Infections


Sexually transmitted diseases (STDs) remain a major public health challenge in the United States. The Center for Disease Control estimates that
there are approximately 19 million new STD infections each year, with almost half occurring among young people 15 to 24 years of age. The cost
of STDs to the United States health care system is estimated to be $15.9 billion annually. Chlamydia, gonorrhea, and syphilis cases represent
only a fraction of the complete STD landscape in the United States as many cases of STDs including human papillomavirus and genital herpes are
under reported. 39
Chlamydia. Rates for Chlamydia in Los Angeles County have been historically higher than both the national and state rates. The rate of
Chlamydia in LA County was 442.8 per 100,000 compared to the California rate of 390.8 per 100,00040 and the national rate of 401.3 per
100,000. Among all reportable sexually transmitted infections, Chlamydia is the most common in the United States as well as in Los Angeles
County; it accounted for 79.1% of all STD cases in the county (LAC/DHS, 2008)41 and has been increasing steadily from 2004 to 2008.
In 2008, within SVMCs primary service area, SPA 6 reported the highest rate of Chlamydia cases with 960.0 cases per 100,000. However, this
was a decrease from 2005 (859.5 per 100,000). In both 2005 and 2008, SPA 6 had the highest rate of Chlamydia cases in Los Angeles County.
Gonorrhea. The incidence of reported gonorrhea cases in Los Angeles County has started to decrease every year since 2006. Currently it
accounts for 15.1% of STD infections in Los Angeles County. In 2008, the infection rate in Los Angeles County was higher than Californias rate
but less than national rate (LAC/DHS, 2008). In 2008, gonorrhea affected 111.6 per 100,000 individuals the United States, 66.7 per 100,000 in
California, and 84.7 per 100,000 in Los Angeles County.
In 2008, within SVMCs primary service area, SPA 6 reported the highest rate of gonorrhea cases with 246.5 cases per 100,000, down from 2005
(290.1 cases per 100,000). In both 2005 and 2008, SPA 6 had the highest rate of gonorrhea cases in Los Angeles County.
Syphilis. Incidence rates for primary and secondary syphilis fluctuated in the last few years. Currently the number of reported syphilis cases has
decreased from 2007 to 2008. It accounts for a little over one percent of the STD infections in Los Angeles County. In 2008, the incidence of
reported primary and secondary syphilis was higher in Los Angeles County than in California and the United States (LAC/DHS, 2008). In 2008,
Syphilis affected 4.5 per 100,000 in the United States, 5.7 per 100,000 in California, and 7.3 per 100,000 in Los Angeles County.
In 2008, within SVMCs primary service area, SPA 4 reported the single highest rate of syphilis with 22.5 cases per 100,000 in Los Angeles County,
up from 2005 (16.8 per 100,000). In both 2005 and 2008, SPA 4 had the highest rate of syphilis cases in Los Angeles County
39

CDC Sexually Transmitted Disease Surveillance, 2008


CA Sexually Transmitted Disease, 2008
41
LA County Sexually Transmitted Disease Morbidity Report, 2008
40

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

I. MENTAL HEALTH
Mental health services was consistently cited by focus group and interview participants as one of the least available services in the community.
More than most health issues, mental health illnesses carry a lot of stigma in communities of color. For instance, participants suggested that
cultural norms and biases in Latino and African American communities sometimes deter potential patients from seeking mental health care.
Similar perception was found in the Asian community. One participant said that mental health issues continued to be stigmatized in the Thai
community even after the Thai Consulate brought mental health professionals from Thailand to educate the community.
There are also structure problems that make mental health care less accessible. Participants stated that many community clinics do not have
mental health professionals on staff and referrals to mental health services are limited by what is available in the community. Some participants
also cited the restricted nature of mental health funding and the priority of trauma over prevention. One participant explained, DMH
[Department of Mental Health] doesnt allow for a mental wellness approach which a lot more people can benefit from. It doesnt allow for
creativity. We have a partner in the community who has been able to expand their healing center to offer acupuncture, traditional
psychotherapy, yoga and other movement classes. It integrates a little bit of Eastern philosophy, all at no cost or cost. None of this was
fundable by DMH.
Unfortunately, the reduction in mental health services comes at a time of economic recession when the demand for these services sharply
increases. Participants believed that unemployment and foreclosure are two major stressors that lead to an increase in depression and anxiety,
which in turns leads to poor management of existing health and chronic conditions. Mental health issues tend to impact recent immigrants
disproportionately, especially during economic downturn. One participant said, A lot of low income immigrant families are suffering from some
type of depression and anxiety, as well as the somatic issues that could arise from it. In addition to adjustment to an unfamiliar dominant
culture, many recent immigrants find themselves in a tightening underground economy where it is harder to eke out a living. This is coupled
with a harsh political environment that calls for more immigration control. For example, in the Korean community, according to participants
who serve that community, stress from coping with a bad economy has led to a rise in alcoholism, family violence and suicides.

1. Mental Illness, Patients Under 20 Years Old


During community focus groups, access to mental health was a top priority for parents. There was a heightened concern with the mental health
of children, particularly teenagers. Community based organization also expressed the need for more mental health services in the communities
they serve throughout Los Angeles County.
In 2007 there were an estimated 100,000 children in Los Angeles County between the ages of 3 and 17 years whose parents reported being
unable to afford mental health care or counseling in the past year for their child. In SVMCs primary service area, SPA 6 had the highest number

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

of children in Los Angeles County ages 3 to 17 years (22,000) whose parents were unable to afford mental health services for them in the past
year. In SPA 4, the second highest in Los Angeles County, there were an estimated 17,000 children whose parents were unable to afford mental
health services for them in the past year. Please see Figure 100 for more data.
Figure 100. Percentage of Children (3 17 years) Unable to Afford Mental Health Care or Counseling in the Past Year by SPA, 2007
Percentage
4.2%

Los Angeles County


Service Planning Area
Antelope Valley (1)
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

3.5%
3.3%
2.9%
6.3%
3.9%
7.1%
3.4%
4.3%

Estimated #
100,000
3,000
16,000
12,000
17,000
4,000
22,000
12,000
16,000

Source: 2007 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County
Department of Public Health.

2. Alcohol Drug Use and Induced Mental Illness


In 2009, a total of 1052 alcohol drug use and alcohol drug induced mental illness cases were reported within SVMCs primary service area, with
zip codes 90027 (108) and 90046 (97) reporting the highest number of cases (Office of Statewide Health Planning and Development, 2007).
Figure 101. Number of Alcohol and Drug Related Mental Illness Cases in SVMCs Primary Service Area, 2007
Zip Code
90004
90005
90006
90007
90008
90010
90011
Los Angeles County
California

Total #
69
34
43
25
43
1
59
11,692
34,967

Zip Code
90016
90017
90018
90019
90020
90026
90027

Total #
49
27
52
50
29
72
108

Zip Code
90028
90029
90031
90037
90044
90046
90057

Total #
82
32
35
42
66
97
37

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Source: Office of Statewide Health Planning and Development (OSDPD) 2007

3. Depression
Since the last community needs assessment in 2007, the most frequently cited mental health issue continues to be depression. Similarly, focus
group and the Los Angeles County Health Survey (LACHS) indicate that depression diagnosis in Los Angeles County has increased every year from
1999 to 2007 (see Figure 103). Women, older adults, and Native Americans, in particular, had the highest rates of depression in Los Angeles
County.
Almost 14% of respondents in the LACHS reported being diagnosed with depression in 2007, a 4% increase from 2002 and a 5% increase from
1999. This is higher than the estimated 6.7 percent of adults in the United States in a given year affected by depression (NIMH, 2008). Although
depression among both males and females increased from 1999 to 2007, females showed a greater increase (11.0% to 16.6%). Depression also
increased among all age groups. Respondents between the ages of 50 59 years reported the highest level of depression (19.0%) followed by
those between the ages of 60 64 years (18.2%).
In 2007, 13.6% of adults in Los Angeles County were diagnosed with depression (up from 12.9% in 2005). In SVMCs primary service area, the
percentage of adults diagnosed with depression in 2007 was equal to or higher than Los Angeles County (13.6% in SPA 6 and 14.6% in SPA 4).
From 2005 to 2007, the largest increase occurred within SPA 4 (from 11.9% to 14.6%). SPA 6 also experienced an increase of 12.2% in 2005 to
13.6% in 2007 (Figures 102 103).

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 102. Percentage of Adults (18+ years) Diagnosed with Depression in SVMCs Primary Service Area, 2007

Source: 2007, 2005, 2002 03, 1999 00 Los Angeles County Health Surveys; Office of Health Assessment and Epidemiology,
Los Angeles County Department of Public Health

Figure 103. Percentage of Adults (18+ years) Diagnosed with Depression by SPA, 2007
2007
Percentage
Estimated #
Los Angeles County

2005
Percentage

2002 03
Percentage

1999 00
Percentage

13.6%

1,009,000

12.9%

9.7%

8.8%

San Fernando (2)

13.5%

212,000

12.8%

10.4%

9.7%

San Gabriel (3)

12.4%

171,000

11.2%

9.0%

7.2%

Metro (4)

14.6%

136,000

11.9%

11.0%

9.6%

West (5)

13.2%

69,000

16.6%

11.7%

8.8%

South (6)

13.6%

92,000

12.2%

7.0%

6.9%

East (7)

13.4%

128,000

13.2%

9.7%

8.7%

South Bay (8)

13.8%

159,000

13.7%

9.4%

9.8%

Service Planning Area

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Source: 2007, 2005, 2002 03, 1999 00 Los Angeles County Health Surveys; Office of Health Assessment and Epidemiology, Los Angeles County
Department of Public Health
19. Estimates may differ from prior estimates as new weights were utilized beginning March 20, 2006.

4. Attention Deficit Hyperactivity Disorder (ADHD)


The National Institute of Mental Health (NIMH) reports that 20% of American youth are affected with a mental disorder in their lifetime. Of
those 20%, 10% of children were affected by a behavioral disorder such as attention deficit hyperactivity disorder (ADHD). In addition, 40% of
respondents who reported having a disorder also met the criteria for having at least one additional disorder. Los Angeles County Survey results
from 2007 indicate that higher educated households had higher rates of ADHD, with occurrences in twice as many boys compared to girls.
Roughly one out of every 20 children in Los Angeles County was diagnosed with ADHD, with the highest frequency in children aged 12 17 years
old. In SVMCs primary service area, both SPA 4 (5.2%) and 6 (4.8%) were below the Los Angeles County rate (5.3%).
Figure 104. Percentage of Children (3 17 Years) Diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Percentage
Estimated #
5.3%
126,000
5.8%
4.5%
5.2%
6.8%
4.8%
3.4%
6.9%

27,000
19,000
13,000
6,000
14,000
12,000
26,000

2002
Percentage
4.5%

1999
Percentage
5.3%

5.7%
4.0%
2.2%
5.8%
4.1%
4.2%
4.5%

4.9%
5.1%
5.1%
7.4%
6.1%
4.4%
5.5%

Source: 2007, 2002 and 1999 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County
Department of Public Health.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

J.

COMMUNITY AND SOCIAL ISSUES

1. Domestic Violence
Actual domestic violence (DV) numbers are difficult to measure due to inconsistent data on the occurrence and circumstances of each DV event
and dissimilar data sources. For example, data sources may be reported at the national, state or local level and information is collected
dependent upon that agencys mission or focus. County DV statistics are culled from three sources: law enforcement and criminal justice
systems, the healthcare and public health systems, and self reported surveys. More importantly, none of the aforementioned data sources are
linked in any way that could present a more complete view of the cycle of DV.42
Domestic violence data is reported in the following categories: severe cases like homicides, hospitalizations for DV related injuries, emergency
room visits, and self reported victimizations. Additionally, DV victimization without severe physical injury cases is less likely to be reported
therefore true numbers are unknown.43
Overall, the number of state and County DV related incidences is on the decline. The number of deaths due to assaultive injuries (homicides)
among adolescent and adult females ages 10 44 saw a quick drop off from the three year period of 1997 1999 to the next three year period
from 1998 2000; following that six year span to 2004 2006 existed a constant decline; however, it has been minimal. Starting in 1997 1999, the
County three year rate per 100,000 female deaths due to homicide was higher than the state three year rate (3.8 per 100,000 vs. 3.2 per
100,000). More recently, Los Angeles County has seen larger decreases in the rate of DV related homicides than the state.44
Figure 105. Domestic Violence Death Due to Homicide Among Females (ages 10 44 years), 2006
Three Year
Average
1994 1996
1995 1997
1996 1998
1997 1999
1998 2000
1999 2001
2000 2002

Number
387
350
300
277
256
253
257

California
86% Confidence Interval
Rate
Lower
Upper
4.6
4.1
5.0
4.1
3.7
4.5
3.5
3.1
3.9
3.2
2.8
3.6
2.9
2.6
3.3
2.9
2.5
3.2
2.9
2.5
3.2

Number
146
129
114
96
98
93
99

Los Angeles County


86% Confidence Interval
Rate
Lower
Upper
5.9
4.9
6.8
5.2
4.3
6.1
4.6
3.7
5.4
3.8
3.1
4.6
3.9
3.1
4.6
3.6
2.9
4.4
3.9
3.1
4.6

42

LA Department of Public Health, Domestic Violence Data Sources, Injury & Violence Prevention Program
LA Department of Public Health, Domestic Violence Data Sources, Injury & Violence Prevention Program
44
LA County Department of Public Health
43

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Three Year
Average
2001 2003
2002 2004
2003 2005
2004 2006

Number
264
246
234
230

California
86% Confidence Interval
Rate
Lower
Upper
2.9
2.6
3.3
2.7
2.4
3.0
2.5
2.2
2.9
2.5
2.2
2.8

Number
94
90
85
87

Los Angeles County


86% Confidence Interval
Rate
Lower
Upper
3.7
2.9
4.4
3.5
2.8
4.2
3.3
2.6
4.0
3.4
2.7
4.1

Note: Because there is no domestic violence specific external cause of injury (E Code) in the current Classification of Diseases (ICD) codebook, the
numerator in this template reflects deaths due to all types of assault except data for California 2000. Prior to 1999, ICD 9 codes E960 E969 were
used; after 1999. ICD 10 codes U01 U02, X85 Y09 and Y87.1 were used. Data from California Department of Public Health, Epidemiology and
Prevention for Injury Control (EPIC) Branch does not include ICD 10 code Y87.1 for assault (homicide) by all other and unspecified means and the
sequelae.
Source: California Department of Public Health, Center for Health Statistics, OHIR Vital Statistics Section, 1994 2005
Denominator data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 1970 2050, Sacramento, California, May
2004
Denominator data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 2000 2050, Sacramento, California, July 2007

In 2006, Los Angeles County reported 0.4 per 100,000 female (13 and over) hospitalizations due to assaultive injuries by a spouse or partner;
almost half the rate compared to the state at 0.7 per 100,000 female hospitalizations over the same year. Historically, the number of County
reported DV hospitalization cases are less frequent than state trends.45
Figure 106. Domestic Violence Hospitalizations Due to Violent Injuries Among Females (ages 13 and over), 2006
Year

Number

1997
1998
1999
2000
2001
2002
2003
2004
2005
2006

199
157
141
156
120
90
103
124
129
102

California
95% Confidence Interval
Rate
Lower
Upper
1.5
1.3
1.7
1.2
1.0
1.4
1.0
0.9
1.2
1.1
1.0
1.3
0.9
0.7
1.0
0.6
0.5
0.8
0.7
0.6
0.8
0.8
0.7
1.0
0.9
0.7
1.0
0.7
0.5
0.8

Number
38
37
38
33
31
21
26
23
30
18

Los Angeles County


95% Confidence Interval
Rate
Lower
Upper
1.0
0.7
1.4
1.0
0.7
1.3
1.0
0.7
1.3
0.9
0.6
1.1
0.8
0.5
1.1
0.5
0.3
0.8
0.6
0.4
0.9
0.6
0.3
0.8
0.7
0.5
1.0
0.4
0.2
0.6

Note: ICD 9 CM Diagnosis E967.3 Perpetrator or child or adult abuse by spouse or partner or by ex spouse or ex partner
45

LA County Department of Public Health

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Sources: California Office of Statewide Health Planning & Development, Patient Discharge Data. Prepared by California Department of Public
Health
Epidemiology & Prevention for Injury Control (EPIC) Branch, Injury Surveillance & Epidemiology Section. Data retrieved on September 22, 2008.
Denominator data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 1990 1999, Sacramento, California, May
2004.
Denominator Data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 2000 2050, Sacramento, California, July
2007.

Historically, spousal abuse arrest rates have been similar between California and Los Angeles County. For example in 2006, 1.4 per 1,000 adults
18 and over was arrested in Los Angeles County for a domestic violence incidence and 1.6 per 1,000 was arrested statewide.46
Figure 107. Domestic Violence Adult Arrests for Spousal Abuse, 2006
California

Los Angeles County


Lower 95% Upper 95%
CI
CI
2.7
2.8
2.4
2.4
2.1
2.2
2.0
2.1

Year

Total

Male

Female

Rate

1997
1998
1999
2000
2001

63,636
56,892
52,128
51,225

53,778
47,519
43,104
41,885

9,858
9,373
9,024
9,340

2.7
2.4
2.2
2.1

52,392

42,662

9,730

2.1

2.1

50,479

40,885

9,594

2.0

48,854

39,325

9,529

46,353
45,083
43,911

37,235
36,116
32,264

9,118
8,967
8,647

2002
2003
2004
2005
2006

Lower 95% Upper 95%


CI
CI
2.8
2.9
2.6
2.6
2.3
2.4
2.1
2.2

Total

Male

Female

Rate

18,725
17,190
15,776
14,706

15,819
14,330
13,029
11,911

2,907
2,860
2,747
2,795

2.9
2.6
2.3
2.1

2.1

15,227

12,351

2,876

2.2

2.1

2.2

1.9

2.0

13,899

11,234

2,665

2.0

1.9

2.0

1.9

1.8

1.9

12,931

10,485

2.2446

1.8

1.8

1.8

1.7
1.7
1.6

1.7
1.7
1.6

1.8
1.7
1.6

11,911
11,206
10,741

9,633
9,120
8,665

2,278
2,088
2,076

1.6
1.5
1.4

1.6
1.5
1.4

1.7
1.6
1.5

Sources: California Department of Justice Statistics Center, Review of Domestic Violence Statistics, 1990 2003, Data retrieved June 12, 2007.
California Department of Justice Statistics Center, Special Request Unit, 2004 2005 data received by fax June 11, 2007.
California Department of Justice Statistics Center, Special Request Unit, 2005 data received by fax September 23, 2008.
Denominator data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 1970 2050, Sacramento, California, May 2004.
Denominator Data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 2000 2050, Sacramento, California, July 2007.

From 1997 to 2002, Los Angeles County received a higher rate of domestic violence phone assistance calls to a law enforcement agency. This
trend has reversed starting in 2003. From 2003 to 2006 the state received more DV assistance calls. The current County DV assistance phone
call rate is 5.9 per 1,000 adults ages 18 and over versus 6.4 per 1,000 statewide.47
46
47

LA County Department of Public Health


LA County Department of Public Health

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 108. Domestic Violence Related Calls for Assistance in the Adult Population (ages 18 and over), 2006
Year
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006*

Number
of Calls
220,156
196,832
186,406
196,880
198,031
196,569
194,288
186,439
181,362
176,299

California
86% Confidence Interval
Rate
Lower
Upper
9.5
9.4
9.5
8.3
8.3
8.4
7.7
7.7
7.7
7.9
7.9
8.0
7.8
7.8
7.9
7.6
7.6
7.7
7.4
7.4
7.4
7.0
7.0
7.0
6.7
6.7
6.7
6.4
6.4
6.5

Number
of Calls
67,805
62,278
59,834
60,960
59,661
56,661
56,452
48,041
45,684
43,508

Los Angeles County


86% Confidence Interval
Rate
Lower
Upper
10.4
10.3
10.5
9.4
9.4
9.5
8.9
8.8
9.0
8.8
8.8
8.9
8.5
8.5
8.6
7.9
7.9
8.0
7.3
7.3
7.4
6.6
6.5
6.7
6.2
6.2
6.3
5.9
5.8
5.9

Note: Currently there is no standard definition of or reporting system for domestic violence. Domestic violence is a complex issue involving many
social and psychological forces. Therefore, reliance on a single indicator does not present a complete picture of the problem. The begin
addressing these barriers, it is important to identify the existing data sources and understand their advantages and limitations. Local police
jurisdictions mandated reporting on domestic violence related calls for assistance is one data source commonly used to describe the
frequency of domestic violence in California, because it is population based and easily accessible. However, these data only illustrate local
law enforcement practices and response to domestic violence calls and are not an adequate source for measuring either the prevalence or
incidence of domestic violence injuries.
*Data cannot be broken down by age; therefore, calls included both adults and juveniles.
Sources: California Department of Justice Statistics Center, Division of Law Enforcement, Law Enforcement Information Center Special Report,
Total Domestic Violence Calls Received by Type of Weapon, by County, 1990 2001.
California Department of Justice Statistics Center, California Criminal Justice Profile, 1998 2005.
California Department of Justice Statistics Center, Special Request Unit, 2006 data received by email on September 23, 2008.
Denominator data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 1990 1999, Sacramento, California,
May 2004.
Denominator Data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 2000 2050, Sacramento, California,
July 2007.

In Los Angeles County, over two thirds of DV related emergency calls to law enforcement involved weapons, such a firearms; knives; other
weapons; and hands, fists or feet.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 109. Domestic Violence Related Calls for Assistance Involving Weapons, 2006
Los Angeles County
Year
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006

Domestic Violence related calls for assistance


Number with
Number of Calls
Proportion (%)
Weapon
67,805
71.6%
48,559
62,278
70.0%
43,619
59,834
71.2%
42,573
60,960
72.2%
44,029
59,661
71.7%
42,796
56,452
70.9%
40,017
52,790
71.6%
37,817
48,041
71.7%
34,430
45,684
71.9%
32,862
43,508
67.7%
29,445

Number by Type of Weapon


Knife or Cutting Other Dangerous
Instrument
Weapon
2,122
5,558
1,852
5,055
1,706
5,034
1,846
5,568
1,639
5,760
1,657
5,758
1,639
5,560
1,481
4,766
1,353
4,449
1,229
3,881

Firearm
781
622
612
682
637
753
671
513
528
460

Hands, Fist, Feet,


etc.
40,098
36,090
35,221
35,933
34,762
31,849
29,860
27,670
26,532
23,875

*Data cannot be broken down by age; therefore, calls included both adults and juveniles.
Sources: California Department of Justice Statistics Center, Division of Law Enforcement, Law Enforcement Information Center Special Report, Total Domestic Violence Calls Received by Type of
Weapon, by County, 1990 2001.
California Department of Justice, Criminal Justice Statistics Center, California Criminal Justice Profile 1996 2005.
California Department of Justice, Criminal Justice Statistics Center, Special Request Unit, 2006 data received by email September 23, 2008.

2. Child Abuse and Neglect


Children under one year old have the highest rates of child abuse or neglect, at a rate of 22 per 1,000 cases in 2007. In California, one in eight
(12.5%) abused children were under the age of one in 2008 a rate of 21.6 per 1,000 infants. In Los Angeles County, more than one in ten
(10.7%) abused children were under the age of one a rate of 20.5 per 1,000 infants. The most commonly reported child abuse was physical
abuse (48%), neglect (22%), sexual abuse (8%) and emotional abuse (7.5%). Child abuse is very serious as it can result in death or serious physical
or emotional harm. In 2007, over 794,000 children were abused in the United States and 1,760 (2.35 per 100,000) died as a result of abuse.48
Figure 110. Substantial Maltreatment Reports for Children Less Than One Year, Rate per 1,000 children, 2008

California, Age Group Under 1


Year
48

African American

White

Hispanic

Asian/Pacific
Islander

Native American

Missing

TOTAL

69.2

19.8

19.8

6.2

69.7

33.9

21.6

LA's Best Babies Network, Perinatal Scorecard 2010

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Los Angeles County, Age Group


Under 1 Year

65.7

15.4

19.1

5.0

45.1

11.7

20.5

Source: LA's Best Babies Network, Perinatal Scorecard 2010

3. Teenage Pregnancy
Each teen pregnancy cost taxpayers an average of $4,080 per year and each child born to a teen mother costs an additional $1,430 per year, for
an estimated total of $270 million every year in public health care, child welfare, incarceration, and lost tax revenue49. In Los Angeles County,
nearly 1 in 10 live births, or 15,000, was to women under the age of 19. The birth rate among Hispanic/Latinas from 15 17 years of age is 12
times higher than Asian teen mothers and 7 times higher than White teen mothers. The birth rate among African American teens 15 17 years of
age is 6.5 times higher than White teens.
In SVMCs primary service area, SPA 6 had the highest percentage of teen births in Los Angeles County at 13.5%. Additionally, SPA 4 was
higher than Los Angeles Countys 9.8 percent teen birth rate (2005)50.

4. Immigration
The United States immigrant population has nearly doubled from 1990 to 2006, from 20 million immigrants in 1990 to 37 million immigrants in
2006. The Urban Institutes MetroTrends 2008 found most immigrants originate from Latin America and Asia, and contribute diversity to
Americas top 100 metro areas. Californias immigrant population is still the largest in the nation and continues to increase; however, that
growth has slowed in the late 1990s and quickened in the 2000s.
In 2007, 26% of all immigrants relocated to California, down from 1990 (33%). Californias working age immigrant population grew 9.5%
annually from 1980 to 1990; however, it increased by half that by only 4.4% annually from 1990 to 2000, and half that by only 2% annually from
2000 to 2007. Historical immigrant destinations like Los Angeles County grew by only 1.8% per year from 1990 to 2007, compared to 11.9%
growth per year in Riverside County and 9.9% in Kern County. Alameda, San Bernardino, Riverside, Kern, and Sacramento Counties had the
fastest growing immigrant populations since 1990. The growth in Alameda and Sacramento Counties was due primary to an increase in new
immigrant arrivals, while growth in Kern, Riverside and San Bernardino stems more from relocation by more established immigrants. Riverside
and San Bernardinos relocation growth was mainly from Los Angeles County.51

49

LA's Best Babies Network, Perinatal Scorecard 2010


LA's Best Babies Network, Perinatal Scorecard 2010
51
The Public Policy Institute of California, New Patterns of Immigrant Settlement in California, July 2009
50

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

A recent study led by The Public Policy Institute of California (PPIC), found that both documented and undocumented immigrants, particularly
Latinos, are moving to new locales that are outside traditional immigrant geographies and social networks to destinations based strongly on
better economic opportunities. Specifically, PPIC found that immigrants employed in the construction, manufacturing, and some service
industries are less likely to choose to live in California than they were in 1990. In 2000, new immigrants in California had higher levels of
education on average than in 1990. Furthermore, there was no evidence that the generosity of welfare programs affected choices. PPICs study
suggests that Californias ability to attract highly skilled immigrants to its workforce is linked to economic conditions relative to other states. In
addition, these demographic shifts have policy implications at the federal, state, and local level because many communities are confronting
issues of integrating immigrants for the first time.52
In California, the largest immigrant population in 2008 originated from Latin American (54.6%), and nearly one third of that population resides in
Los Angeles County. In addition, nearly one third of the Asian immigration population in California resides in Los Angeles County (please see
Figure 111 for details). In Los Angeles County, a large percentage of the immigration population in 2008 originated from Latin American (59.9%)
and Asia (32.1%). The same was true in the 2007 community needs assessment; however, there was a larger percentage of Asians (32.1%) in
2007 than in 2005 (27.4%). In 2009, 41.0% of foreign born people were born in Mexico (smaller percentage than California, 43.3%)53.
Figure 111. Foreign Born Population in Los Angeles County 2008 estimates
Europe
Asia
Africa
Oceania
Latin American
Northern American

% of population
5.4%
32.1%
1.4%
0.4%
59.9%
0.9%

Estimated #
186,069
1,112,673
49,705
12,873
2,076,954
31,985

California (%)
6.9%
34.8%
1.5%
0.8%
54.6%
1.4%

Estimated # in CA
683,972
3,431,501
144,966
75,589
5,387,639
135,212

Source: American Community Survey 1 Year Estimates, 2008.

The majority of the population in Los Angeles County that is foreign born are between the ages of 25 and 64 (49.8%), and 65 and above (42.5%),
much higher than in California (37.5% and 29.7%, respectively). Please see Figure 112 for more data.
Figure 112. Foreign born population by Age Group in Los Angeles County, 2008
Age group
04
5 17
52
53

% of population
2.2%
9.0%

California (%)
2.1%
8.35%

The Public Policy Institute of California, New Patterns of Immigrant Settlement in California, July 2009
U.S. Census Bureau, 2009, American Community Survey

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18 24
25 64
65 and Above

27.4%
49.8%
42.5%

22.2
2%
37.5
5%
29.7
7%

Source: U.S Census Bureau, American Comm


munity Survey, 2008.

5. School Drop
pouts

Fiigure 113. High School Dropout Rates by Californiia County, 2008

In 2007, the Califfornia Departmen


nt of Education (CDE) calculated high school
dropout rates for the first time using student levvel data, as oppo
osed to less
accurate school level data. CDEs new methodology the adjusted
d four year
derived dropout rate is an esstimated percenttage of public high school
dropouts over fo
our years based on a single year'ss data (numerato
or) and the
grade 9 12 dropout count (deno
ominator). Thereffore, CDEs new and more
robust derived drropout rates will only draw data for 2008 since co
omparisons
before or after arre invalid. Los An
ngeles Countys youth gang involvvement and
felony arrest rate
es were below sttate averages; ho
owever, dropout rates were
higher in the Co
ounty of Los An
ngeles. In California, an estimatted 98,420
D
ta
students (18.9%) in grades 9 12 dropped out of high school in 20
008. In Los
13.0%
% to 19.3%
Angeles County, the percentage was 21.0% nearly one out of every four
% to 37.5%
students in Los Angeles County drropped out of higgh school in 2008
8. As Figure
% to 73.5%
data.org
113 highlights, drropout rates varied widely at the county level, as well as the
school district le
evel. Statewide and across its counties, African
n American
(32.9%), Native American/Alaskaa Native (24.1%), Hispanic/Latin
no (23.8%),
Multiple Race/No Response (23.3%), and Pacific Islander (21.3%) students gen
nerally were mo
ore likely to dro
op out of high school than
Caucasian/White (11.7%), Filipin
no (8.6%), and Asian (7.9%) stu
udents. Educatio
onal research sh
hows that dropo
outs are more likely to be
unemployed and receive public asssistance.54

6. Self Reportted Health Statu


us
Of the estimated
d 1.4 million resiidents in Los Angeles County, neearly one out fivve (18.5%) self reeported they had
d fair to poor heealth status.
Looking back to 1999 2000 longitudinal survey datta, it shows a decline of 2.4%. In 2007, figures aree the lowest on record for the Department of
54

Kidsdata.org

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Public Healths Survey. SVMC SPA 4 (22.8%) and 6 (270.1%) reported a higher percentage of those in fair to poor health than Los Angeles County
(18.5%).
Figure 114. Percentage of Adults (18+ years) who Reported Fair/Poor Health Status by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2007
Percentage Estimated #
18.5%
1,375,000
15.8%
19.4%
22.8%
7.4%
27.1%
19.1%
17.4%

249,000
267,000
213,000
39,000
183,000
183,000
202,000

2005
Percentage
20.6%

2002 0319
Percentage
20.3%

15.4%
19.1%
25.5%
10.6%
33.4%
23.2%
20.5%

17.3%
20.2%
23.4%
11.4%
28.5%
23.1%
19.8%

1999 00
Percentage
20.9%
15.4%
20.1%
28.5%
14.5%
28.2%
24.3%
19.9%

1997
Percentage
20.5%
14.7%
22.2%
24.9%
12.5%
31.5%
24.2%
17.9%

Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health.

7. Average Number of Unhealthy Days


In 2007, the average number of unhealthy days in Los Angeles County was 5.4 days; this is down from 6.4 days in 2005. A similar trend is seen
across all SPAs. In SVMCs primary service area from SPAs 4 (5.8) and 6 (6.8) had a higher average of adults with unhealthy days in the past 30
days than Los Angeles County.
Figure 115. Average Number of Unhealthy Days (Mental and/or Physical) in the past 30 days for Adults (18+ years) by SPA, 2007
2007
Los Angeles County
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)

2005

2002 03

1999 00

Average
5.4

Average
6.4

Average
6.1

Average
6.4

5.3
5.1
5.8
4.2
6.8

6.7
5.7
6.2
6.1
7.9

5.7
6.1
6.7
5.4
6.6

6.4
5.8
7.0
6.0
5.9

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

East (7)
South Bay (8)

5.1
5.3

6.2
6.2

6.2
6.1

5.8
7.2

Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA
County Department of Public Health.

8. Carbon Monoxide
Good air quality is especially important for good health. The quality of air is one of Southern Californias biggest challenges. According to the
California Air Resource Board, by January of 2005, Southern Californians average carbon monoxide reading was 2.3 parts per million (ppm) and
by the end of the same year it doubled to 4.3 ppm. It is worth noting that monitoring of carbon monoxide (CO), nitrogen dioxide (NO2) and
sulfur dioxide (SO2) is not currently required anywhere in California.

9. Parks and Open Spaces


The number of parks and open spaces are vital to both the environment and good health. Figure 116 below details the number of protected
acres per 1,000 for each zip code within the SVMCs primary service area.
Figure 116. Protected Areas per 1,000 People (Acre) in SVMCs Primary Service Area, 2009
Zip Code
Per 1,000 People (Acre)
90004
0.03
90005
0.05
90006
0.14
90007
0.72
90008
11.54
90010
90011
0.61
90016
3.49
90017
90018
0.18
90019
0.15
0.16
90020
90026
2.85
90027
57.09
90028
0.16

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Zip Code
90029
90031
90037
90044
90046
90057

Per 1,000 People (Acre)


0.10
6.32
1.59
0.32
8.03
0.88

Data Source: California Protected Areas Database v1.3, 2009


= data not available

10. Particulate Matters


Particulate Matter (PM10) is among the most harmful of all air pollutants and affects most children, the elderly, active adults, and those
suffering from asthma or bronchitis. PM10 air particles are less than 10 microns in diamete about 1/7th the thickness of the human hair. These
harmful particles are a mixture of emissions from motor vehicles, wood burning stoves and fireplaces, dust from construction, landfills,
agriculture, wildfires and brush/waste burning, industrial sources, and windblown dust. This mixture of smoke, soot, dust, salt, acids, and metals
undergo chemical reactions in the atmosphere. When inhaled, they can increase the number and severity of asthma attacks, aggravate
bronchitis and other lung diseases, and reduce the body's ability to fight infections.55
The National Ambient Air Quality Standards for PM10 over a 24 hour average is 150 g/m3 and the annual standard average is 50 g/m3. State
Ambient Air Quality Standards for PM10 over a 24 hour average is 50 g/m3 and the annual standard average is 20 g/m3. Southern California
experienced one red day in January 2005 and five red days in December 2005 where the national standard PM10 level was exceeded. In
comparison, the South Coast Los Angeles County Air Basin did not exceed national PM10 standard levels during the same period. Average PM 10
levels were 40.6 in January and 98.4 in December for Southern California compared to 18.7 and 28.9 micrograms/cubic Meter (ug/m3) for the
South Coast Basin.

11. Housing
11.1 Housing Units
There are nearly 13 million households in the state (12,652,259) of California. And one in four households was located in Los Angeles County
(3,234,680).56 The distribution of the number of households across Service Planning Area show that the San Fernando area ranks highest with
the most number of households at 21.4%, followed by San Gabriel at 17.4% and South Bay at 15.9%.
55

CA Air Resource Board Particulate Matter (PM10) Air Pollution Fact Sheet, 2009

133

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Figure 117. Number of Househo


olds by SPA, 2009
Number off
Householdss
3,234,680

Percenttage of Los
Angele
es County
100%

S
Service
Planning Area
A
S Fernando (2)
San

702,175

21
1.7%

S Gabriel (3)
San

563,935

17
7.4%

M
Metro
(4)
West (5)
W

438,522

13
3.6%

296,203

9.2%

SSouth (6)

256,441

7.9%

East (7)

360,211

1.1%
11

SSouth Bay (8)

515,512

15
5.9%

3,132,999

96
6.9%

LLos Angeles Countty

C
Cumulative

Source HealthyCity.org(Nielsen Claritas, Inc), 2009. Data is approximaated.

In SVMCs primarry service area, th


he largest amoun
nt of households are located in 900
046 (29,388), 900
026 (25,034), and
d 90016 (24,782)..
Figure 118.. Number of Households by SVMC
Cs Primary Serviice Area, 2009

3,234
4,680

Percentage of Los
Angeles County
A
100%

9000
04

23,8
817

0.74%

9000
05

16,4
478

0.51%

9000
06

20,0
088

0.62%

9000
07

13,1
122

0.41%

9000
08

13,4
493

0.42%

9001
10

Number of Households
Los Angeles County
Zip Codes

56

94
40

0.03%

9001
11

22,8
898

0.71%

9001
16

16,7
785

0.52%

HealthyCity.org, 20
009

134

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

90017

8,858

90018

0.27%

15,931

0.49%

90019

24,782

0.77%

90020

18,442

0.57%

90026

25,034

0.77%

90027

23,119

0.71%

90028

15,320

0.47%

90029

14,306

0.44%

90031

10,817

0.33%

90037

15,545

0.48%

90044

25,589

0.79%

90046

29,388

0.91%

90057

16,608

0.51%

Cumulative

371,360

11.48%

Source HealthyCity.org(Nielsen Claritas, Inc), 2009

11.2 Occupied Versus Vacant Units


In 2010, there were a large number of occupied units in Los Angeles County (96.4%) than vacant units (3.6%). In SVMCs primary service area,
zip code 90046 has the most occupied units (29,388). However, zip code 90044 (2,148), 90011 (1,821), 90037 (1,502), and 90026 (1,444) have
the largest number of vacant units.
Figure 119. Occupied and Vacant Units in SVMCs Primary Service Area, 2010
# Occupied Units
3,254,203

# Vacant Units
122,563

90004

23,952

764

90005

16,542

599

90006

20,343

915

Los Angeles County


SVMC Zip Codes

135

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

90007

# Occupied Units
13,068

# Vacant Units
721

90008

13,670

762

90010

936

14

90011

22,572

1,821

90016

16,752

864

90017

8,939

638

90018

15,919

983

90019

24,593

1,016

90020

18,354

550

90026

25,071

1,444

90027

23,119

724

90028

15,320

641

90029

14,306

517

90031

10,817

521

90037

15,570

1,502

90044

25,321

2,148

90046

29,388

963

90057

16,265

930

Source HealthyCity.org(Nielsen Claritas, Inc), 2009

11.3 Renter versus Owner Occupied Units


In general, one of the indicators of community poverty is the level of renter occupied housing units. About 79.8% of the housing units in SVMCs
primary service area were occupied by renters. This was significantly higher than the overall County rate of 52.2%. In fact, all of the zip codes in
the primary service area had a higher percentage of renter occupied housing units than the County. In general, one of the indicators of
community poverty is the level of renter occupied housing units. The following zip codes had higher percentages of renter occupied housing
units than the County overall (in decreasing order): 90017, 90057, 90028, 90020, 90005, 90006, 90029, 90007, 90004, 90010, 90027, 90026 &
90046, 90019, 90037, 90011, 90031, 90018, 90044, 90008, and 90016.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 120: Owner vs. Renter Occupied Housing Units in SVMCs Primary Service Area, 2009
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Service Area
Los Angeles County

Owner Occupied Housing Units


4,168
17.5%
1,368
8.3%
1,707
8.5%
1,614
12.3%
4,548
33.7%
175
18.6%
6,161
26.9%
6,397
38.2%
134
1.5%
4,884
30.7%
6,575
26.5%
1,499
8.1%
5,731
22.9%
4,624
20.0%
685
4.4%
1,506
10.3%
3,308
30.2%
4,129
26.6%
8,513
33.3%
6,716
22.9%
719
4.3%
75,161
20.2%
1,542,275
47.8%

Renter Occupied Housing Units


19,649
82.5%
15,110
91.7%
18,381
91.5%
11,508
87.7%
8,945
66.3%
765
81.4%
16,737
73.1%
10,361
61.8%
8,724
98.5%
11,047
69.3%
18,207
73.5%
16,943
91.9%
19,303
77.1%
18,501
80.0%
14,731
95.6%
13,174
89.7%
7,641
69.8%
11,416
73.4%
17,076
66.7%
22,597
77.1%
15,889
95.7%
296,705
79.8%
1,687,122
52.2%

Source: Nielsen Claritas, Inc., 2009


Note: Bolded numbers indicate lower percentage than Los Angeles County overall of owner occupied housing units

In 2010, SPA 4 had the largest percentage of renters (76.9%) in all of Los Angeles County, followed by SPA 6 (58.9%). Subsequently, both SPA 4
and 6 had the smallest percentage of homeowners (23.1% and 41.1%, respectively).
Figure 121. Owner vs. Renter Occupied Housing Units by SPA, 2010
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)

Owner Occupied Housing Units


381,386
54.0%
332,903
60.9%
100,893
23.1%

Renter Occupied Housing Units


325,548
46.1%
213,800
39.1%
336,678
76.9%

137

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politan Hospital Co
ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

Service Plannin
ng Area
West (5)
South (6)
East (7)
South Bay (8)
Los Angeles County

Ow
wner Occupied Hou
using Units
12
23,291
41.4%
04,573
10
19
96,248
24
47,536
1,57
78,828

41.1%
54.5%
48.4%
48.5%

Renter Occcupied Housing Un


nits
174,414
58.6%
150,057
163,963
263,511
1,675,375

58.9%
45.5%
51.6%
51.5%

Source: Nielsen Clarritas, Inc., 2010

11.4 Units in Stru


ucture
Of the housing sttructures in the SVMC primary seervice area, 11.4%
% had 50 or moree units (compareed to 8.2% in Los Angeles County overall) and
17.1% had betwe
een 20 and 49 units (compared to 8.9% in Los An
ngeles County ovverall). In generral, a high percentage of units in
n a structure
nsity and povertyy (lower percentaage of single hom
mes and homeow
wnership). The fo
ollowing zip codees had higher perrcentages of
indicate both den
housing units witth 50 or more un
nits than that of Los Angeles Coun
nty overall (in deecreasing order): 90010, 90020, 90017, 90057, 90
0028, 90005,
90046, 90004, 90
0027, 90007, and 90006. Please seee Figure 122 for data.
Figure 122. Units in Structurre in SVMCs Prim
mary Service Areaa, 2009
Zip Code
e
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031

Structure with 50++ Units


2,915
11.9%
4,369
25.6%
1,824
8.7%
1,319
9.5%
367
2.6%
368
38.6%
239
1.0%
508
2.9%
3,232
34.0%
1,001
5.9%
743
2.9%
6,518
34.3%
1,024
3.9%
2,834
11.9%
4,820
30.0%
1,025
6.7%
293
2.6%

Structure
e with 20 49 Units
5,180
21.1%
%
5,740
33.6%
%
5,172
24.6%
%
2,193
15.9%
%
2,009
14.1%
%
219
23.0%
%
754
3.1%
%
848
4.8%
%
3,669
38.6%
%
1,419
8.4%
%
1,933
7.5%
%
7,225
38.0%
%
2,395
9.1%
%
4,746
19.9%
%
5,214
32.5%
%
2,758
18.1%
%
502
4.4%
%

138

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politan Hospital Co
ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

Zip Code
e
90037
90044
90046
90057
Service Area
Los Angeles Co
ounty

Structure with 50++ Units


500
2.9%
500
1.8%
4,296
14.2%
5,795
33.0%
44,490
11.4%
275
5,916
8.2%

Structure
e with 20 49 Units
934
5.5%
%
948
3.4%
%
6,487
21.4%
%
6,430
36.6%
%
66,775
17.1%
%
297,534
8.9%
%

Source: Nielsen Claritas, Inc., 2009


mbers indicate zip codess with higher percentagge than Los Angeles Cou
unty overall of structures with 50+ units
Note: Bolded num

In 2010, SPA 4 had the largest peercentage of stru


uctures with 50 or more units (16
6.3%) in all of Lo
os Angeles Countty. However, SPA 6 had the
smallest percentaage of structuress with 50 or moree units (3.2%) and
d the smallest peercentage of structures with 20 to
o 49 units (4.7%) in all of Los
Angeles County.
Figure 123. Unitts in Structure byy SPA, 2010
Service Plannin
ng Area
San Fernando (2
2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)
Los Angeles Cou
unty

Structures with 50+ Units


77,090
10.6%
30,984
5.5%
74,664
16.3%
36,662
11.8%
8,622
3.2%
18,560
5.0%
39,747
7.5%
28
88,374
8.5%

Structurres with 20 49 Unitts


85,121
11.7
7%
25,658
4.6%
%
80,170
17.5
5%
38,940
12.5
5%
12,815
4.7%
%
18,591
5.0%
%
39,559
7.5%
%
303,217
9.0%
%

Source: Nielsen Claritas, Inc., 2010

11.5 Median Hom


me Value
Median home values in SVMCs primary service arrea range betweeen $120,000 and $899,680. Wheen taking into acccount that 23% of families in
SVMCs primary service area and
d have an income ranging betweeen $17,861 and $48,587, homess values are disp
proportionally higgh and vary
widely. Median home values are particularly high in zip code 90046
6 ($899,680), 900
010 ($850,000), and 90027 ($809,2
222).

139

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 124. Owner Occupied Median Home Values in SVMCs Primary Service Area, 2010
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057

Median Home Value


$707,348
$690,761
$392,932
$380,192
$481,582
$850,000
$308,514
$350,194
$120,000
$365,250
$588,977
$382,792
$455,994
$809,222
$491,500
$493,555
$317,409
$323,634
$314,271
$899,680
$246,954

Source: Nielsen Claritas, Inc., 2010

11.6 Vehicle Available


In Los Angeles, the mode of transportation is vital to everyday existence. Commuters need to get from point A to point B across a vast geography
to complete the basic, everyday tasks such as going to school or daycare; completing doctor visits; or buying groceries and medications.
Therefore, it is clear that the percentage of commuters that have one or two vehicles available at home is higher at the Los Angeles County level
and for most Service Planning Areas. However, in SVMCs primary service area, a significant proportion of residents in SPAs 4 and 6 do not have a
vehicle at home, 20.3% and 17.3% each.

140

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politan Hospital Co
ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

Figure 12
25. Number of Paassenger Cars, Vaans, and Pickup/Panel Trucks Kep
pt at Home and Made Available for
f Use by SPA, 2010
Number of Vehicle
es

N
None

1 Vehicle

2 Vehicles

3 Vehicles

4 Vehicles

5 Vehicles

T
Total

State of
California
954,982
7.6%

Los Angeles
County

San
Fernando
SPA (2)

305,159
9.4%

44,395
6.3%

4,029,228
31.9%

1,121,110
34.7%

4,761,045
37.6%

1,146,346
35.4%

1,946,827
15.4%

439,506
13.6%

670,089
5.3%

154,453
4.8%

290,088
2.3%

68,106
2.1%

12,652,259

3,234,680

San
n Gabriel
S
SPA
(3)

Metro
o SPA
(4
4)

West SP
PA
(5)

South SPA
(6)

East SPA (7)

South Bay
SPA (8)

5.8%

88,,785
20..3%

17,497
7
5.9%

43,985
17.3%

28,568
7.9%

43,152
8.4%

230,505

1
160,329

189,,063

127,56
60

97,333

108,227

181,605

32.8%

28.4%

43..2%

42.8%
%

38.2%

30.1%

35.3%

276,873

2
214,393

114,,389

111,47
78

70,001

129,220

188,127

39.4%

38.0%

26..1%

37.4%
%

27.5%

35.9%

36.6%

101,044

1
101,142

30,4
406

29,951
1

27,949

59,227

69,177

14.4%

17.9%

7.0
0%

10.1%
%

11.0%

16.4%

13.5%

34,963

3
37,810

9,7
771

8,282
2

9,994

24,380

23,136

5.0%

6.7%

2.2
2%

2.8%

3.9%

6.8%

4.5%

14,395

1
17,553

5,1
157

3,237
7

5,368

10,589

9,209

2.1%

3.1%

1.2
2%

1.1%

2.1%

2.9%

1.8%

702,175

5
563,935

437,,571

298,00
05

254,630

360,211

514,406

3
32,708

Source HealthyCity.org, 2010

11.7 Average Len


ngth of Residencee
To measure the rate of residential stability and efffects of migration
n overall mobility the census, tracks the percentage of the pop
pulation who
has remained att their residencee for more than one year. This information is vital for age and
d gender estimaates; small area projections;
employment, hou
using, education, and the elderly programs; public facilities; and firee and police statiions.

141

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

In California, more than four out of five residents (84.5%) remained in the same house more than one year; 14.7% moved to a different
residence and an additional 0.8% moved outside the Los Angeles County, 87.4% remained in the same house; 11.9% moved to a different
residence and an additional 0.7% moved abroad57.
11.8 Year Housing Structure was Built
In 2010, the majority of housing structures in Los Angeles County were built between 1950 1959 (21.1%), 1960 1969 (16.2%), and 1970 1979
(14.5%). The remainder of housing structures were built between 1939 or earlier (12.3%), 1940 1949 (11.7%), 1980 1989 (11.6%), 200 or later
(6.4%), and 1990 1999 (6.2%).
In SVMCs primary service area, the majority of homes were built in 1930 or earlier (26.1%), between 190 and 1959 (15.9%), or between 1960
and 1969 (14.7%).
11.9 Transition Services for Adults with Pediatric Illness
In 2005, more than one out of seven children (15.7%) in Los Angeles County met the criteria for having special health care needs.58 According to
Kidsdata.org, a comprehensive data and information website that provides over 300 indicators on the health and well being on Californias
children, reported that more than one third (37.1%) of Californias youth with special care needs received support services for the transition to
adulthood in 2005 2006. In the United States, slightly more youth (41.2%) received transition to adulthood support services than in California.
Based on Californias children with special health care needs (CSHCN) statistics, almost half (42.2%) of CSHCN received care within a medical
home that is, a basic level of care that is ongoing, comprehensive, coordinated, and family centered. Measures of transitional support services
are vital given the overall increases in childhood chronic conditions such as asthma; attention deficit/hyperactivity disorder (ADD/ADHD);
diabetes; and depression; and with the advances in medicine means longer survival rates for children who are living well into adulthood.59

12. Safety/Crime
In 2006, the California Department of Public Health reported a total of 802 homicides by firearms for Los Angeles County (California Department
of Public Health, 2006). In SVMCs primary service area, there were a total of 141 homicides by firearm. The highest number of homicides by
firearm occurred in zip codes 90011 (31), followed by 90044 (24).

57

2007 American Community Survey via HealthCity.org


Los Angeles County Health Survey, 2005
59
Kidsdata.org, 2005 2006
58

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 126. Homicides by Firearm in SVMCs Primary Service Area, 2006


Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057

#
7
0
7
0
10
0
31
9
0
13
6
0
8
0
0
0
0
20
24
0
6

Source: California Department of Public Health (CDPH), 2006


Zeros indicate less than 5 deaths

13. Safe Parks


The percentage of parents in SVMCs primary service area with children under the age of 18 who reported having easy access to a safe, green
space for their children to play have generally improved from 1999 to 2007, excluding SPA 6 with a negligible drop from 62.7% in 1999 to 62.6%
in 2007 (please see Figure 123 for data). Additionally, most SVMC SPAs report higher proportions of accessible safe parks than the Los Angeles
County rate of 79.8%. Only SPA 4 (69.7%) and SPA 6 (62.6%) reported less safe parks than Los Angeles County.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 127. Percentage of Children (1 17 Years) whose Parents Reported Easy Access to a Park, Playground or Other Safe Place for their Child
to Play by SPA, 2007

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West** (5)
South (6)
East (7)
South Bay (8)

Percentage
79.8%
83.9%
85.3%
69.7%
87.5%
62.6%
85.0%
83.1%

2007
Estimated #
2,124,000
443,000
391,000
206,000
94,000
218,000
339,000
351,000

2005
Percentage
83.1%
83.9%
87.4%
73.1%
85.1%
72.1%
86.1%
90.0%

2002 03
Percentage
82.7%
86.7%
84.7%
72.4%
89.3%
70.3%
88.3%
85.6%

1999 00
Percentage
75.9%
77.9%
80.4%
68.4%
78.3%
62.7%
78.7%
81.5%

Source: 2007, 2005, 2002 and 1999 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County
Department of Public Health.

14. Gentrification, Specifically Downtown L.A.


Beginning in 1999 with the Adaptive Reuse Ordinance policy which enacted the conversion of specified commercially zoned property into
residential property, Downtown Los Angeles has experienced an unprecedented residential population growth even during the economic
downturns. Since the last Downtown Los Angeles Demographic Study in 2006, residents, employers and visitors have not only seen renewed
growth in residential units, but also in new restaurants, nightspots, high end grocery stores, and the new entertainment center, L.A. LIVE. These
new offerings will be complemented with the extension of the forthcoming Gold Line light rail, the Convention Center Hotel, and the Cineplex at
L.A. LIVE. From 2006 to 2008 the downtown area has seen a 36.9% increase in both residential population growth (from 28, 878 residents in
2006 to 39,537 residents in 2008) and in the number of residential units (18,999 units in 2006 to 26,011 units in 2008). Household size also
increased. The average number of residents per downtown household was 1.6 in 2006 and 1.8 in 2008.60
The Downtown Center Business Improvement Districts 2008 Downtown LA Demographic Study reported that 78% of downtown residents
completed college or higher levels of education, earned a median income of $96,200, and a third were at a top/professional staff level. Nearly
two thirds (64.3%) of the population were between 23 and 44 years of age with a median age 37 Demographically, Downtown Los Angeles is
becoming somewhat more ethnically diverse with a growth in both Hispanic/Latino and African American residents.

60

DCBID Downtown LA Demographic Study 2008

144

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 128. Downtown Los Angeles Residential Race/Ethnicity, 2008

53.2%

2008
53.8%

2 Year Percentage
Change
0.6%

Asian/Pacific Islander

24.9%

20.9%

4.0%

Hispanic/Latino

10.1%

17.4%

7.3%

African American

5.3%

8.3%

3.0%

Race/Ethnicity

2006

White

Source: DCBID Downtown LA Demographic Study 2008

Surveyed downtown respondents from 2006 and 2008 reported similar own versus rent residential living. Thirty percent owned their home
compared to 60% who rented; an additional 10% had other living arrangements. Nearly two out of three (63.5%) downtown residents worked in
the city in 2008 compared to more than one of two (55.1%) residents who reported working in the city in 2006. This upsurge may represent
residents choosing to live, work and play in Downtown. Seventy three percent of respondents admitting to spending their main activity dining
out in one of downtowns many trendy new restaurants or entertainment centers. In 2006, only 58% responded that their main downtown
activity was dining out.61

15. Homeless, Specifically New Homeless


On a given day, or point in time, in 2009, the Los Angeles County homeless count was 48,053 people. This is a significant drop of 34.8% from
2007 where there were 73,702 homeless people and an even larger drop of 41.6% from 2005 when the Los Angeles Homeless Services Authority
reported 82,291 homeless persons. Some of the reasons attributed to the decline were new and expanded programs including the Countys
$100 million Homeless Prevention Initiative, the City Permanent Supportive Housing Program, and the expanded Section 8 voucher programs
that specifically target the homeless. This is coupled with a shift in program focus on homeless placement and the City of LA and the County
government focus on expanding collaborative efforts to reduce homelessness.62
Within the Los Angeles Continuum of Care network, which includes all of Los Angeles County 67% of its 42,694 homeless were living on the
streets, in parks, vehicles, abandoned buildings, or other non emergency or transitional housing facility (e.g. unsheltered). Figure 129 below
details sheltered and unsheltered homeless persons for the Los Angeles Continuum of Care by Service Planning Area. In 2009, the largest
number of homeless persons resided in SVMC SPAs 4 (5,121) and 6 (2,157).

61
62

DCBID Downtown LA Demographic Study 2008


Los Angeles Homeless Services Authority, 2009 Greater Los Angeles Homeless Count: A Summary Report

145

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ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

Figure 129
9. Los Angeles Co
ontinuum of Care
e by Sheltered an
nd Unsheltered Persons by SPA, 2009
Sheltered

Unsheltered

Tottal
Num
mber

LA Continuum of
o Care*

Number
14,050

Pe
ercentage
33%

Nu
umber
28
8,644

Percen
ntage
67%
%

Service Planningg Area


San Fernando (2)

1,515

46%

1
1,797

54%
%

3,312

San Gabriel (3)

1,010

36%

1
1,770

64%
%

2,780

Metro (4)

5,121

46%

5
5,972

54%
%

11,0
093

West (5)

1,707

31%

3
3,831

69%
%

5,538

South (6)

2,157

25%

6
6,357

75%
%

8,514

East (7)

1,236

27%

3
3,281

73%
%

4,517

South Bay (8)

810

21%

3
3,144

79%
%

3,954

Unknown SPA

50

9%

517

91%
%

56
67

42,6
694

* Includes City of Loss Angeles


hority
Source: Los Angeles Homeless Services Auth

Figure 130.. Los Angeles Con


ntinuum of Care by Gender and Ethnicity, 2009
Gender
Adult Male
Adult Female
Male Childreen (Under 18)
Female Child
dren (Under 18)
Ethnicity
Black/African American
Hispanic/Lattino
White/Caucaasian
American Indian/Alaskan Nativve
Asian/Pacificc Islander

Num
mber

Perccent

25862
13,,730
2,0
026
1,0
076

60%
32%
5%
%
3%
%

19,,886
12,,631
8,9
924
783
470

47%
29%
21%
2%
%
1%
%

Source: Los Angeles Homeless Services Authority

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ollaborative SB 697
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nt 2010

A survey of home
eless persons in the City of Los Angeles and the Los Angeles Contiinuum of Care was administered from March thro
ough May of
2009. Survey results indicated th
hat homeless sub
bpopulations by gender were 60%
% adult male, 32
2% adult female, and 8% males and females
under the age of eighteen. Subpopulations by ethn
nicity reflected a majority of Africcan Americans (47%); followed byy Hispanic/Latinoss (29%), and
Whites (21%). The remaining 3% comprised of American Indian/Alaaskan Native and Asian/Pacific Islaanders.

16. Food Insecu


urity
As stated in the 2007 communityy needs assessment, living in foo
od insecure houseeholds is related to poor diets, which can lead to
o nutritional
deficiencies and poor health (LAC
CDHS, 2007)63. No
ot having sufficieent food and the nutrients it provides can impair the growth and development
in children. It caan also cause streess and increase the risk for deprression in adolesscents. Insufficieent food can also
o cause obesity in
n adults and
malnutrition in older adults. In 2007, of the adults living in food insecure households in Californiaa (2,875,000), 35% were living in Los Angeles
County64. Also in 2007, 36.3% of adults in Los Angeeles County weree experiencing food insecurity, up from 28.3% in 20
005 (CHIS)65.
In SVMCs primary service area:
ngeles County, of food insecurityy and had the largest percentagge of adults
SPA 6 haad the largest peercentage, of alll SPAs in Los An
diagnosed with diabetes or borderline diab
betes (15.8%).
PA, 2007
Figure 131. Trrends in Food Inssecurity among Households by SP
2007

2005

Number
1,013,000
0

e
Percentage
36.3%

Perccentage
28.3

Servicce Planning Area


San Feernando (2)

144,000

34.1%

28.0

San Gabriel (3)

193,000

38.0%

32.1

o (4)
Metro

145,000

32.8%

31.7

West (5)

28,000

32.1%

13.3

h (6)
South

178,000

39.5%

31.1

7)
East (7

140,000

36.0%

20.9

South Bay (8)

159,000

38.1%

28.9

ngeles County
Los An

63

LA Health Trends: Food Insecurity Increeasing in Los Angeles County


California Food Pollicy Advocates, 2010 Los Angeles County Nutrition and Food Insecurity Profile; California Health Intervview Survey (CHIS)
65
California Health In
nterview Survey (CHIS)
64

147

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ollaborative SB 697
7 Community Health Needs Assessmen
nt 2010

Source:: California Health Interrview Survey, 2007

As previously me
entioned, not haaving sufficient food negatively affects certain age groups differrently. The dataa shows that in Los Angeles
66
County:
In 2007, 57.4% of adults were overweight or obese.
12.9% of children were co
onsidered overweeight for their agee.
h borderline or pre diabetes.
In 2009, 10.9% had diabettes and 0.9% werre diagnosed with
In 2007, in SVMCs primary servicee area:
SPA 6 (15
5.8%) had the higghest percentage of people with diabetes, and high
her than Los Angeeles County (10.9
9%).

32. Percentage off Adults Diagnose


ed with diabetess or borderline/p
prediabetes by SP
PA, 2009
Figure 13
Diabetic
10.9

Borderline/pre
ediabetic
0.9

ng Area
Service Plannin
San Fernando (2
2)

6.4

0.9

San Gabriel (3)

13.9

1.2

Metro (4)

8.3

0.8

unty
Los Angeles Cou

West (5)

8.3

0.8

South (6)

15.8

0.6

East (7)

12.7

0.6

South Bay (8)

12.4

0.9

Source: California Health Interview Surveyy, 2009

66

California Health In
nterview Survey

148

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17. Economy (Downturn)


The United States economy started its latest downturn in 2007 with the fall of the housing market, subsequent record breaking financial crisis
and deep recession by the end of 2008, continuing into 2009.
The beginning of 2007 was welcomed with the biggest drop in both new and existing home sales since the early 1990s and the Dow Jones
suffered the biggest one day point loss since 2001. Freezing temperatures in California caused a $1.3 billion los in revenue. By the end of the
same year, banks, mortgage lenders, real estate investment trusts, and hedge funds continued to suffer significant market losses as a result of
mortgage payment defaults and mortgage asset devaluation. In California, sales of new and existing homes were down 39% from the previous
year in November and foreclosure rates were at record highs.67
In the following year, by October 2008, the Dow Jones Industrial Average had its most volatile day ever in its 112 year history. By November,
Japan was in a recession, in December the United States faced its own recession, and Britain faced the same fate in January 2009, right after
Barack Obama became the 44th President of the United States. Immediately thereafter, President Obama began his $787 billion economic
stimulus package called the American Recovery and Reinvestment Act of 2009 that included a combination of spending measures and tax cuts.
To promote housing stability, the President created the Homeowner Affordability and Stability Plan in February. Throughout the remainder of
2009, the GDP continued to drop and Chrysler and General Motors were bankrupt. The national poverty rate was 14.3% the highest rate since
1994 and Californias income levels fell for the first time since World War II. The recession ended for the United States by June 2009.68
By February 2010, the fourth quarter GDP report declared an increase of 5.9%. President Obama signed legislation to extend jobless benefits to
Americans. For California, the start of 2010 fared better than the first half of 2009. Record unemployment rates of 2009 were replaced with job
expansion in the industry sector in 2010. In June, manufacturing added 7,300 jobs; trade, transportation, and utilities added 5,600 jobs;
professional and business services added 1,500; education and health services added 800; mining and logging added 600; and leisure and
hospitality added 400. Overall, economic indicators were skewed due to the 2010 Census job recruitment and expiration of the federal First
Time Home Buyers Tax Credit. Despite this, the unemployment rate dipped for the third consecutive month to 12.3% in June and new home
construction permits were up 29% from the previous year and nonresidential building permits were up 7.3%.69
Participants believed that the economic downturn in the past few years have exacerbated the deterioration of community health. One
participant stated that unemployment in South Los Angeles has risen to 20% since the beginning of the recession. The accompanying housing
crisis has led to increased homelessness, including those from the middle class who have lost their jobs or their homes. Some health advocates
67

California Department of Finance, Chronology of Significant Events


California Department of Finance, Chronology of Significant Events
69
California Department of Finance, 2010 California Economic Indicators
68

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

called for more support for low income housing, including senior housing for those seniors who have lost their savings in the recession, as a way
to stabilize community health. One participant also stated that the recession causes situational depression, and by virtue of extreme poverty
and the stressors that come with it, also substance abuse, marital discords, and hopelessness in general. In addition to the depression and
anxiety, some participants also attributed an increase in diabetes rate to economic stress.

18. Unemployment and Job Market


Preliminary October 2010 unemployment data indicate that Californias unemployment rate is at 12.0%. Los Angeles County is slighter higher at
12.5%. Comparatively, Los Angeles County is ranked 28th in California. Los Angeles Countys unemployment percentage rate is lower compared
to San Bernardino Countys 13.7% percentage rate, Kern Countys 14.4% percentage rate, and Riverside Countys 14.7% unemployment
percentage rate. Orange and Ventura County were below Los Angeles Countys unemployment rate, at 9.1% and 10.5% respectively.70
The Los Angeles County Economic Development Corporations forecasts that the U.S. GDP will increase by 2.9% and the leading sectors will be in
consumer spending and business equipment investment while nonresidential construction and state/local spending will lag behind. By 2011 the
states economy is predicted to increase non farm employment by 1.3% and the industry leaders will no longer be in private education or
information; by 2012, it will be in leisure/hospitality and retail trade. The administrative/support services industry will continue to do well into
2011; manufacturing and government related employment will continue to decline. Job growth is expected to be in the positive territory for all
Southern California counties, especially for San Diego and Orange counties. Los Angeles County is expected to grow the least at 1.2% compared
to 1.4% for San Diego and Orange Counties. In terms of job growth within Los Angeles Countys sub regions, the Central/Downtown LA area will
remain at 0.0% as well as for the Crenshaw/Mid Cities/Hollywood sub area. San Fernando Valley will dip at 0.1%, as well as for the San Gabriel
Valley at 2.3%.71

19. Alcohol Distributors


The availability of certain commodities, such as alcohol, in a community can affect both mental and physical behaviors of its residents.
addition, the number of alcohol distributors may also affect the rates of binge and chronic drinking.

In

In 2009, 22% of alcohol distributors72 in California were located in Los Angeles County (California Department of Alcoholic Beverage Control). Of
the total alcohol distributors in Los Angeles County (14,176), 22% were located in SVMCs primary service area. The two zip codes with the

70

CA Employment Development Department, Monthly Labor Force Data for Counties, Preliminary October 2010
Los Angeles Economic Development Corporation, Kyser Center for Economic Research, Economic Forecast, July 2010
72
Alcohol distributors include bars, restaurant, liquor, grocery, and convenience stores.
71

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highest number of alcohol distributors within the primary service area were zip codes 90028 (188), 90046 (130), 90010 (128), 90026 (102), and
90005 (96).
Figure 133. Number of Alcohol Distributors in SVMCs Primary Service Area, 2009
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057

#
88
96
128
48
14
51
76
38
60
28
83
92
102
99
188
79
48
41
42
130
47

Source: California Department of Alcoholic Beverage Control, 2009

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Figure 134. Number of Alcohol Distributors in SVMCs Primary Service Area, 2009

Source: California Department of Alcohol Beverage Control (ABC), 2009


Note: Service zip codes represent the top five zip codes with the highest concentration of alcohol disttributors
within the service area.

Figure 135. Percentage of Adults who Reported Binge Drinking* in the Past Year by SPA, 2009

Los Angeles County


Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)

2009
Estimated
Percent
#
2,014,000
27.0%
27.5%
22.1%
27.8%
29.2%
25.2%
30.2%
29.3%

424,000
313,000
261,000
150,000
173,000
301,000
333,000

2007
Percent
27.8
27.9%
21.2%
33.9%
31.4%
23.6%
30.5%
29.1%

Estimated #
2,038,000
425,000
294,000
298,000
163,000
158,000
289,000
342,000

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Source: 2009, 2007 California Health Interview Survey


*Males are considered binge drinkers if they consumed 5 or more alcoholic drinks on at least one occasion in the past year. Females
are considered binge drinkers if they consumed 4 or more alcoholic drinks on at least one occasion in the past year.

20. Alcohol Outlets per 1,000 people


As mentioned in the above alcohol distributors section, the number of alcohol distributors can affect the surrounding communities negatively.
In SVMCs primary service area, zip code 90010 also had a large number of alcohol outlets per 1,000 people (23.02), followed by 90028 (5.95).
Figure 136. Number of Alcohol Outlets per 1,000 in SVMCs Primary Service Area, 2009
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020

Rate per 1,000


1.25
2.08
1.92
1.03
0.45
23.02
0.70
0.77
2.17
0.55
1.17
1.95

Zip Code
90026
90027
90028
90029
90031
90037
90044
90046
90057

Rate per 1,000


1.37
1.94
5.95
1.78
1.18
0.68
0.45
2.53
0.94

Source: California Department of Alcoholic Beverage Control, 2009

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II. Qualitative (Primary Data)


Community Focus Groups
Focus groups were conducted across Los Angeles County as part of the 2010 community needs assessment in order to gather information from
community members and Community Based Organizations (CBOs) about health issues facing local communities. CBOs included agencies that
provide health, social, and other types of services. Information was gathered to identify areas of needs and services available or lacking to meet
those needs. There were two types of focus groups conducted in order to collect information from both the community member perspective as
well as the CBO perspective. In addition, an online survey was made available to CBOs who were unable to attend a focus group. In total, there
were ten focus group conducted (5 with community members and 5 with CBOs). A total of 158 participants attended one of the 10 focus
groups. They were conducted in either English or Spanish, with a mixed age group, and they included both males and females. These focus
groups took place in a variety of sites throughout Los Angeles County. Please see Figure 136 for specific information about each of the focus
groups.
Figure 137. Focus group characteristics, 2010
City/Site

Characteristics

Primary Language

Participants

Community Based Organizations

1
2
3
4
5

Burbank/Buena Vista Library


Los Angeles/Esperanza
Community Housing
Los Angeles/Center for
Nonprofit Management
Los Angeles/Center for
Nonprofit Management
Online *

Various agencies including health,


social, and other service providers.
Community promotoras; Hispanic;
male and female; mixed age group.
Various agencies including health,
social, and other service providers.
Various agencies including health,
social, and other service providers.
Various agencies including health,
social, and other service providers.

English

55

Spanish/English

English

English

14

English

Spanish

19

Spanish

20

Community Members

6
7

Los Angeles/Hope Street


Family Center
Los Angeles/Hope Street
Family Center

Hispanic males (fathers); mixed age


group.
Hispanic females (mothers); mixed age
group.

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8
9
10

City/Site
Los Angeles/St. Barnabus
Senior Services
Los Angeles/Amanecer
Community Counseling
Services
Pasadena/ City of Pasadena
Human Services and
Recreation Department

Characteristics
Mixed ethnicity; seniors; males and
females.
Hispanic; mixed age group; males and
females; parents.
Mixed ethnicity; mixed age group;
males and females.

Primary Language

Participants

English

12

Spanish

English

16

Total

158

* An online survey was made available for those who were unable to participate in focus groups.

A. Health Issues and Trends


Community Based Organization (CBOs). CBOs were asked to identify the most prevalent health needs in the communities they served. The
following health topics were identified by all CBO focus groups: mental health, diabetes, and obesity. Mental health issues affect everyone.
Those affected are experiencing stress, depression, anger management issues, and are sometimes suicidal (especially teenagers). The high
prevalence of mental health needs in local communities has increased since the previous community needs assessment. When asked why they
thought this was the case, CBOs attributed the rise to a variety of reasons that included the high unemployment rate, the rise in community
violence, and isolation caused by the lack of person to person connection resulting from the dependency in technology to communicate. The
number of adult and children who are obese and/or diabetic has also increased. CBOs mentioned that there is a lack of education for parents
and their children on healthy eating habits and leading a healthy lifestyle (including physical activity). There is also a lack of green space for
children to play and run. Healthy eating options are also not readily available, despite the willingness of some community members to eat
healthier. One CBO mentioned that people want to eat better but that isnt an option for them, or they simply cannot afford it. Other
prevalent issues included the lack of available education on healthy living, dental care, heart disease, and respiratory problems. Dental care,
particularly for children, is problematic because there is a lack of available and affordable services. CBOs noted that there has been an increase
in emergency dental care that includes gum disease, tooth decay, infections, and root canals. For other health issues identified by CBOs please
see figure 137.
Community Members. Community members were also asked to identify the most prevalent health needs/trends in their communities. Similar
to CBOs, they also identified mental health as the top health need/trend in their community. In addition, high blood pressure and high
cholesterol were in the top three identified health needs. Other identified health needs included diabetes and obesity. Please see Figure 138 for
other issues identified by community members.

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Figure 138. Health issues/trends identified by focus group participants


Health issues/trends identified:

Community
Based
Organization

Community
Members
#*

AIDS
Arthritis
Autism
Cancer (including prostate, and sickle cell)
Dental care
Diabetes
Heart disease
High Blood Pressure
High Cholesterol
Lack of education on healthy living
Lack of employment leading to health issues or
exacerbating existing issues
Lack of quality medical treatment
Mental health (anger management, stress, depression,
emotional health, suicide)
Multi diagnosis
Obesity (including children)
Respiratory problems (i.e. asthma, allergies)
Self medication
Specialty care
STDs
Substance abuse (i.e. marijuana)
Tobacco and alcohol
Vision issues

1
1
2
2
3
5
3
1

2
1
3
4
4

3
2
1
5

1
5
3
1

1
2
1
1
2
1
2
1
1

1
2
2

*Total number of focus groups who cited the issue. Blank space indicates no focus group cited the issue.

B. Health Service Needs


Community Based Organization (CBOs). CBOs were asked to identify health services lacking in the communities they serve. The top services
lacking included green space, access to general medical care, mental health services, and health services for the elderly. Green space has
become increasingly sparse, especially with the need to build more housing to accommodate the growing population. Community members felt
156

Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

there is a need for more green space for children to play and engage in physical activity, and also for community gardens that would help in
providing healthier food alternatives. With the budget cuts and the increase in health premiums, access to medical care has suffered especially
in low income communities. Also, with the high unemployment rate in their communities, there has been an increase of those needing mental
health services to treat such emotional issues as stress and depression.
Community Members. Community members identified four services that are lacking including dental, vision, and health services for the elderly
and undocumented individuals. Dental and vision services, some said, were very limited and expensive. With the increase in life expectancy
being 80.3 years of age73, the need for more health services for seniors has increased. Specifically mentioned by seniors, there is a need for
more affordable health services such as dental and vision services. Health services have become nearly impossible for undocumented individuals
to access because they are too afraid, the services are unaffordable, or they are simply denied services by providers.
Figure 139. Health services that are lacking identified by focus groups
Health services that are lacking:

Community
Based
Organization

Community
Members
#*

Access to medical care


Dental services
Green space (to play and community gardens)
Health services for elderly
Health services for homeless
Health services for the undocumented
Mental health (for all)
Vision

2
1
4
2
1

2
1
1

2
1

*Total number of focus groups who cited the issue. Blank space indicates no focus group cited the issue.

C. Barriers
Community Based Organization (CBOs). CBOs were asked to identify barriers that keep the community they serve from accessing health care.
The most identified barriers by CBOs include transportation, immigration status, and language barriers. Some clients do not have access to
reliable transportation or are unable to pay for public transportation. Some clients who are illegally in the country are too afraid to access
health services, especially preventative, for fear of deportation. Those who experience language barriers are unable to communicate with
health care providers in their native language, so either they do not access health care or are unable to understand and communicate with
73 73

County of Los Angeles Department of Public Health, Life Expectancy in Los Angeles County: How long do we live and why? A Cities and Communities Health Report

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health care providers. Other barriers identified include not knowing where to go in their communities for information on available resources,
cultural issues such as stigmas with certain health condition such as mental health, and lack of health literacy.
Community Members. Community members were asked to identify barriers they experienced in accessing health care. All focus groups agreed
that language was the biggest barrier to accessing health care. Community members who do not speak English well or at all have an especially
difficult time communicating with health care providers about diagnosis and treatment. Transportation and not knowing where to go to learn
about available resources were the next most cited barriers by community members.
Figure 140. Barriers to health care identified by focus groups
Barriers to health care:

Community
Based
Organization

Community
Members
#*

Affordability of services (i.e. dental and vision)


Cultural (stigmas and misconceptions)
Dont know where to go to learn about available resources
Economic status
Immigration status
Lack of health literacy (healthier lifestyle)
Language barrier
Services being cut
Transportation
Wait time (ER and community clinics)

1
2
2
1
3
2
3
1
3
1

1
1
4
2
2
1
5
1
4
2

*Total number of focus groups who cited the issue. Blank space indicates no focus group cited the issue.

In addition to identifying barriers, focus group participants were also asked to provide suggestions for addressing them. Please see figure 141
for suggestions.
Figure 141. How to address barriers identified, from two focus groups
Community Based Organization
Advocate for government position to help address needs/barriers
Change laws that affect access (i.e. Arizona law)
Review eligibility requirements for programs in order to allow more
people access
Decrease the price of healthcare

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Community Based Organization


Collaborate and partner to improve access
Work with government agencies
Shift the focus from negative to positive (asset based)
Funding, especially for general operations
Qualified service providers (i.e. dieticians)
Good volunteers that are consistent and dedicated

Community Based Organization (CBOs). Community Based Organizations reported that the most difficult healthy behaviors to promote include
exercise, a healthy lifestyle, not smoking and/or drinking, and mental health. With the decrease of available green space and affordable healthy
eating options, it has become difficult for people to get physical activity or try to live a healthy lifestyle. Although it seems that smoking has
been on the decline, CBOs still note this as a difficult behavior to get people to leave behind. According to CBOs, the number of people drinking
have increased since the previous community needs assessment. That is also the case for those needing mental health services. As one CBO
stated there is a huge service gap for mental health services for everyone. Some CBOs have attributed this to the current economic situation,
particularly in low income communities that have been hardest hit with unemployment. Other behaviors are mentioned in figure xx.
Community Members. Community members also identified exercise and a healthy lifestyle as the most difficult healthy behaviors to promote in
their community. One community member mentioned that its much easier for parents to send their kids to watch TV and play video games
than to take them to the park. As previously mentioned, the availability of affordable healthy food options is also a barrier to leading a healthy
lifestyle. Please see figure 142 for other behaviors mentioned by community members.
Figure 142. Healthy behaviors hardest to promote
Healthy behaviors hardest to promote:

Community
Based
Organization

Community
Members
#*

Being drug free (i.e. marijuana as a medicine)


Exercise
Good health and nutrition
Mental health
Not drinking (especially in youth)
Not smoking
Preventative health care

1
1
1
1
1

1
2
2
1
1
1

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

*Total number of focus groups who cited the issue. Blank space indicates no focus group cited the issue.

D. Health Care Utilization


Community Based Organization (CBOs). CBOs were asked to share what they thought preventative health care meant. One CBO said that that
preventative health care meant avoiding chronic illness. Another said it meant breaking habits, most specifically those bad habits that lead to
poor health. As one CBO stated, its important to understand and clarify what the phrase preventive health care means because it might have
different meanings for health care providers than community members.
Community Members. Community members had similar thoughts as to what preventative health care meant. To community members,
preventive care meant such things as getting physical exams, pap smears, taking vitamins, getting vaccinations, being clean, eating healthy, and
exercising. Overall, community members had good insight into what preventative health care meant. However, as noted earlier, preventative
services are very difficult to obtain.
Figure 143. What preventative health care means to focus group participants
Community Based Organizations
Avoiding chronic illness
Prevention is to break [bad] habits.

Community Members
Preventative care (i.e. pap smears, physicals, taking vitamins)
Vaccination
Cleanliness
Eating healthy
Exercising

Community Based Organization (CBOs). CBOs identified where their clients went to obtain information on available health services. Many of the
places were in their communities such as local churches, market places (i.e. Mercado La Paloma), and community clinics. Other places where
clients obtained information included health fairs, USC Medical Center, emergency rooms, and television commercials.
Community Members. Community members also mentioned that they went to community clinics and hospitals for information on health
services. However, they also mentioned that they called 211 for information, their local WIC office, and other local center such as St. Barnabas
Senior Center and Hope Street Family Center.

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Figure 144. Where do people go for information on health services


Community Based Organizations
Churches
Health fairs
Mercado La Paloma
USC
ER
Television
Community clinics

Community Members
211
Hope Street Family Center
WIC office
Community clinics
St. Barnabas
Hospitals (Veterans, St. Vincent, Good Samaritan)

E. General Community Issues


Community Based Organization (CBOs). CBOs were asked to share thoughts on what roles hospitals could play in addressing the health service
needs out in the community. Many suggestions included the hospitals being more active and involved in the community. CBOs specifically
suggested that hospitals do more outreach to inform the community about available services, more specifically those that are low cost or free.
CBOs also thought that hospitals could have more health fairs either in the community or at their vicinity, provide health education to the
community, provide more health screenings, and be more of a connector to services. Hospitals could also be more transparent to clients
about their medical condition by being culturally sensitive and learning how to communicate with them. Aside from being friendly to the
community, hospitals could also be more open to collaboration with CBOs to provide more services; hospitals could also create health
campaigns in collaboration with local nonprofits, and provide grants to CBOs for longer than one year. For more suggestions please look at
Figure 145.
Community Members. Community members echoed some of the suggestions provided by CBOs including the hospitals providing programming
for the low income and also creating payment plans for those that are unable to pay for services all at once. In addition, community members
would like information (i.e. brochures, etc.) to be provided to them in other languages such as Spanish. They would also like hospitals to have
mobile clinics that go out to schools, parks, and other public spaces where people congregate. More specifically, they would like affordable,
quality medical services including dental and vision.

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Figure 145. Role hospitals could play


Community Based Organizations
Outreach to the community to inform people of available services
(i.e. low cost and free services)
Have more community health fairs
Provide education in the community
Be a connector to services for the community
Be culturally sensitive; learn how to communicate with patients
Share resources with other service providers
Provide more health screenings
Seek out partners to fill the need in the community
Provide transparency to patients about their medical condition
Create health campaigns and partner with local nonprofits
Create programming that reflects their mission
Improve ER wait time
Provide alternative medicine (i.e. acupuncture)
Provide speakers on chronic diseases to go speak at organizations
Continued grant funding versus just one year
Support clinics that provide treatment and help keep people for
utilizing the ER

Community Members
Create low income programming (i.e. payment plans)
Provide information to the community in multiple language (i.e.
Spanish)
Mobile clinics that go out to school, parks, or other public places
Provide affordable dental and vision services
Provide quality medical services

Community Based Organization (CBOs). CBOs also mentioned other community non health issues that might impact health conditions in the
community. Most issues deal with access to such things as healthy foods, housing that is affordable and clean, sufficient food, child care,
services for foster youth, and services for returning veterans. There are also other issues that deal with the increase in violence in the
community and in the home. One CBO mentioned that the increase in domestic violence has increase since 2009 by 49%, and that studies have
shown that families facing severe economic challenges face triple rates of domestic violence.
Community Members. Community members also shared other non health issues in their communities including the increase in teenage parents,
homeless, and in the need for living assistance programs. There has also been a decrease in funding for after school and summer programs, and
funding for child care programs.

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Figure 146. Non health community issues identified in focus groups


Community Based Organizations
Community Members
Increase in teenage parents
Increase in homelessness (new homeless parents, former middle
class)
Housing (safe and healthy)
Healthy relations between children and their parents
Social isolation due to the dependency of technology to
communication (i.e. social skills for teens)
Services for returning veterans
Ghost clinics
Human trafficking
Literacy, unable to read
Domestic violence, increase
Community violence, increase
Gay and lesbian issues
Insufficient food leading to hunger
Access to healthy foods
Accessible child care
Services for foster youth (i.e. after emancipation, transition)

Increase in teenage parents


Increase in homelessness
Increase in need for living assistance programs
Decrease in funding for after school/summer programs
Decrease in funding for child care

Key Informant Interviews


Key informant interviews were conducted with a total of 30 individuals. The interviewees represented health and human service organizations
located in the service areas of the participating hospitals and serving community members. Most interviewees spoke about the issues they
knew most about as part of their role in their organization, but were also able to speak about other health issues not directly related to the
services they provided. They were asked a variety of questions about the communities they serve, more specifically about health trends, health
needs, challenges and barriers to health care, and were also asked to provide suggestions for meeting community members health needs and a
hospitals potential role in meeting those needs.

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A. Health Related Issues and Trends


Health related issues. There are many factors that contribute to the well being or that threaten a communitys health. Key informants were
asked to identify health related issues they observe in the community. The most prevalent health issues identified included diabetes, obesity,
and mental health. Diabetes and obesity seem to go hand in hand. One interviewee said that obesity and diabetes are very common among
youth, particularly in the Hispanic [Latino] community. Another interviewee added that obesity is hardly just a medical issue. There is no pill to
take. Its a city planning issues that had to do with how we access food, what kind of food, open space, and community violence. Mental health
has also become very prevalent, particularly for immigrants. One interviewee stated that for immigrant families experiencing a totally new
environment is a big stressor. Culture shock and the process of acculturation are very stressful. Asthma was also mentioned to be prevalent,
especially with the declining air quality in Los Angeles but also related to poor quality housing. Hypertension and heart disease were also
mentioned as prevalent health issues. Please see figure 147 for other health related issues mentioned.
Figure 147. Health related issues identified by key informants
Health issues identified:
Access to healthcare
Access to specialty care
Acculturation
Adequate prenatal care
Alcohol and drug abuse
Asthma
Closure of clinics/hospital sites limited services
Dental care
Diabetes
Domestic violence
Food insecurity
Health education
Heart disease
Hepatitis B
Homelessness
Hypertension
Lack of affordable healthy food
Lack of developmental services
Lack of preventative care
Limited dental care

# of times mentioned*
1
1
2
1
2
4
3
2
8
1
1
1
3
1
1
3
2
1
1
1

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Health issues identified:


Mental health (depression, stress, anxiety)
More need than can accommodate
Obesity
Poor quality housing
STDs
Teenage pregnancy
Undiagnosed eye and audiology problems

# of times mentioned*
8
1
8
3
1
1
1

*Total number of key informants who cited the issue.

Health trends. Positive and negative health trends were noted by key informants. Positive trends included the reduction of stigmas attached to
mental health and substance abuse, an increase in emphasis on evidence based methods of treatment versus business based and a shift to
empowering consumers by providing bilingual staff and parent partners to assist. Other positive trends include:
Improvement in working with diabetes
Improvement of dermatology
Improvement of Electronic Referral Systems
More people taking personal responsibility for their health
Decrease in smoking
Population shift to 100% Latinos in some areas
More clinics and agencies opening
However, negative health trends were also noted. The most noted negative trends include the rise in obesity (particularly among Latinos and
children), those having a poor diet, diabetes (particularly among children), domestic violence, need for mental health services, decrease in those
who have health insurance (40% to 90%, as one interviewee noted), the increase in the need for specialty care, increase in job insecurity leading
to stress and fear. Other negative trends noted include:
Long waits at clinics
Alcoholism
Bed bugs

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Care for premature babies with long standing medical problems


Child abuse
Demand of Spanish speaking providers
Dental care
Family violence
Gang activities
Getting information to the community on healthy lifestyles/choices
High cholesterol
Heart disease
Homeless
Hypertension
Increase in amputations and blindness
Increase in cost of services and health insurance
Increased consciousness around health
Lack of access to food
Lead levels in homes
More people attending health fairs
Long waits for Neurology and Gastroenterology services
Public assistance programs (food stamps)
Suicide/homicide
Housing (overcrowded)

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

B. Health Service Needs


A variety of health needs were identified by key informants. The most frequently cited health needs were access to specialty care, dental care
services, and mental health services. The need for specialty care has become greater, which has made it much more difficult to obtain specialty
services such as a colonoscopy, mammogram, gastroenterology, and ophthalmology. Dental care services have also become increasingly difficult
to obtain, especially with the budget cuts that affected Denti Cal, which covered dental care for adults with Medi Cal. The need for more
mental health services has become greater, especially with all the distress resulting from unemployment and other societal factors. Please see
Figure 148 for more identified health needs.
Figure 148. Health needs identified by key informants
Health needs identified:
Access to behavioral health services
Access to healthier food options
Access to specialty care
Adequate staff
Caregiver support services
Dental care services
Easy access to fast food
Ethnic specific agencies
Health care cost (services and premiums)
Lack of trauma centers
Mental health services
Stigma around mental health
Transportation
Vision care services
Youth services

# of times mentioned*
2
1
6
2
1
4
1
1
2
1
3
1
1
1
1

*Total number of key informants who cited the issue.

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C. Barriers
Key informants identified a number of barriers that their clients identified in accessing health care. The most cited barrier was transportation.
Many said that often clients did not have access to reliable transportation, could not afford public transportation, or simply live too far from
where they need to go to receive services. Other barriers identified were language barriers and the inability to access health care services. The
ability to communicate with a health care provider is difficult for those individuals that do not speak and understand English well or at all. This
has become more of an issue with the influx of immigrants in recent years. In addition to language barriers, access to health care services in
general, have become more difficult because of overcrowding, limited hours of operation or long wait times. Additional barriers mentioned
include cultural barriers such as stigmas attached to certain conditions (i.e. mental health), immigration status creating fear or stress in obtaining
services, the affordability of health care services especially for the unemployed that have limited economic resources, and the lack of health
insurance. Additional barriers are listed in Figure 149.
When key informants were asked who were the most affected by these barriers, they said that the poor, men, immigrants (especially the
undocumented), working people, the uninsured, seniors, adults, and families with children were the most affected.
Figure 149. Barriers to health care services identified by key informants
Health needs identified:
Transportation
Language barrier
Access to health care services (overcrowding, limited hours, long wait times)
Cultural barriers (i.e. stigmas)
Immigration issues
Affordability of services, esp. for unemployed
Lack of health insurance , esp. adults
Dont know where to go to learn about available resources
Lack of health education
Bureaucracy in working with government agencies when trying to provide
services
Lack of trust of the health care system (dont know the system)/providers
Lack access to child day care
Cultural competency
Going abroad for affordable health services

# of times mentioned*
14
10
10
9
9
8
7
5
4
3
3
3
2
1

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Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010

Health needs identified:


Poor customer service
Lack of services (i.e. dental)

# of times mentioned*
1
1

*Total number of key informants who cited the issue.

Key informants shared suggestions for addressing barriers that include:


Expand hours so that working parents can receive services outside of the regular work day for themselves and their children
Have electronic medical records in order to be able to follow up on clients and their treatment
Lessen requirements that individuals need to meet in order to receive services (i.e. evidence based service delivery model)
Improve wait times
Provide more mental health services
Go out into the community to build relationships with community members
Mobile clinics for schools and other public places
More services that focus on family involvement
More dental care services
Be more culturally competent
Focus more on preventative care
Translate health materials into multiple languages
Create low cost or free services/programs
Most difficult healthy habit to promote:
Following medication dosage
Exercise due to lack of green space
Healthy eating habits
Mental health awareness in certain ethnic communities (Latino and Korean)

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D. Health Care Utilization


Preventative health care. Key informants were asked what their service population knew about preventative health and where they went to
obtain basic health care services. One key informant said that most of his service population didn not utilize preventative health care, that
instead they sought health care only when it was necessary or illness interrupted their school or work schedule. However, those who seek such
care typically do so to obtain basic health care services consider getting immunizations and leading a healthy lifestyle by eating well and
exercising as preventative health care.
To access basic health care services or if not feeling well many go to community health centers, private clinics, dental schools, and other
community organizations. Some may even travel to faraway places such as Mexico. The following is a list of locations that key informants
identified as places where community members go to obtain health care:
USC Emergency Room

Galili

St. Johns Well Child Clinic

San Judas

Medical home

San Miguel

Queenscare

Hudson

Asian Pacific Health Care Venture

CHMC California Medical Hospital Center

Hope Street Family Center

Eisner

Amanecer

Clinica Romero

Childrens Institute
Chronic and specialty care services. Those that need treatment for chronic health issues may sometimes have access to private doctors, but
more often people tend to go to community clinics or county hospitals to access emergency rooms or as part of the referral process. Key
informants reported that some people use other ways to deal with their chronic health issues including using eastern medicine, an unlicensed
provider, or simply choose to deal with the issues on their own and self medicate. However, when dealing with particular issues such as mental
health, some key informants mentioned that it has become increasingly difficult to refer clients out because often there arent enough mental
health professionals on staff to deal with the increasing number of people needing these types of specialty services. Individuals that have a
primary care provider through private insurance are able to obtain referrals for specialty care much easier that those without private insurance.

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E. General Community Issues


Hospitals role in addressing community health needs. Key informants were asked how they thought hospitals could help address some of the
community health needs mentioned earlier. Many mentioned collaboration, specifically how it would be beneficial for clinics and local hospitals
to collaborate, aside from referrals, and to build relationships that would better serve patients. More collaborative care would allow for a well
rounded health safety net where specialty care services such as mental health would be part of primary care. Hospitals could also develop a
referral system to help keep people out of the ER and reduce wait times, create preventive and early intervention programming, provide more
health screenings for Hepatitis B and other chronic diseases, develop healthy living campaigns, and provide health information in multiple
languages. In addition, capacity building suggestions were also shared including providing place based planning with staff and having hospital
staff participate on the boards of community organizations.
Greatest concerns facing service population. Key informants were asked to share what they saw as the greatest concerns and issues facing their
service population. The greatest health concerns in key informants service populations were mental health problems including stress,
depression, and anxiety. Other health concerns included obesity, diabetes, heart disease including hypertension and high cholesterol, asthma in
children, substance abuse including alcoholism, cancer, domestic violence, and dental services. However, there is also concern with the growing
numbers in uninsured or underinsured, funding for health resources, and lack of affordability of medications.
In addition to health concerns, there are also certain concerns in the community that are not directly related to health. The largest concern was
food insecurity. One key informant said that these communities are a food desert; many communities have an abundance of fast foods places
but lack healthy, affordable alternatives. Unemployment is also a large concern. One key informant mentioned that South Los Angeles has been
the hardest hit with an unemployment rate of over 30%. In addition to unemployment, there are also issues with monolingual households, the
rise in the poverty levels, unhealthy living conditions due to multi family residences, increase in foreclosures, and lack of transportation. There
has also been a decrease in after school programming, an increase in teenage pregnancy and school drop outs.

F. Assets
Despite all the issues mentioned by key informants, there have been some positive strides to addressing those issues. There has been an
increase in the amount of health related information and education provided to the community at large. Promotoras and community members
that have taken a leadership role have been crucial to the dissemination of information as they are more in sync with the community and their
needs. This has also increased the communitys involvement through health fairs. At the provider level, there have been increases in the
number of facilities open to provide services, early intervention programs for children have been created, there is more case management to
connect people to the appropriate services and programs, there has been an increase in free testing and screenings made available, there has

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also been an increase in the importance of being culturally sensitive (many organizations are ethnic specific), and there has also been a shift in
focus to the medical home model.
Top 3 priorities. Key informants were asked to share what they thought the top three priorities to be addressed in the coming years. The top
three mentioned priorities were mental health (specifically stress, anxiety), obesity (for all but more specifically in children), and preventative
care. Other priorities mentioned include:
STDs (Chlamydia) (2)
Dental care (2)
Education (2)
Integrated safety net services (2)
Increase collaboration of hospitals with clinics on basic health care (2)
Diabetes
Teenage pregnancy
Asthma
Family preservation
Peptic cancer
Vision care
Substance abuse
In addition, key informants were asked what they felt were some social barriers affecting the top three priorities. They mentioned
gentrification, slum housing, increased poverty, disparity between patients with complex medical needs, increase in gang activity and crime,
increase in domestic violence, and the lack of affordable child care particularly in homes where both parents work.
Best ways to provide information to the community. According to key informants, the best ways to provide health related information to the
community are through marketing (smart messaging), community events such as fairs, and having convenings with both community members
and providers where information and education can be provided. In addition, it would be important to leverage exiting partnerships with
community based resources such as churches to make connections with the community. It would also be useful to provide information and
education in other languages aside from English, and to have culturally competent staff members that are able to communicate appropriately.

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